HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED L�
Date: 1�Ia��t1 Permit Number: yi 1 1 l'' O S5 1
_r- � ' a
Building Permit Application
Planning and Development Services Wit: .......................
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address: �� C_ -j�' o"
Legal Description:
Property Tax ID#: °�3 5 5�0 - Od0 S--daO -� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters P(windows/Doors
Electric _ Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $_Z (1 Q)O ` C Utilities: —Sewer —Septic Building Height:
OWNERAESSEE: CONTRACTOR:
NameName:
Address: �� C L � Company: �� 0,v.
City: ,-� �e�� State:�� Address: L4�`'L sly L t',` k&,
Zip Code: Fax: �1 c� City: �S. State:
R
Phone No. — ( 3 - LY Y / ' 3 1 Zip Code: ��� �( Fax: c�
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
comm,enrinig work or recording our Notice of Commencement
Sig re of Owner/Lessrac or as Agent for Owner =ATE
of Contractor/Licens er
TATE OF FLORID OF FLORI
COUNTY OF k. �.-� c�� COUNTY OF Ly��
The forgoing instrument was acknowledgebefore me The forgoing instrument was acknowledged before me
thisa`) dayof 1J" 20�� by this al day of OoJ 20A by
��. �•�zZ atc,��
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PubQ--State of Florida ) (Signature of Notary blic-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �-- S Produced "'L �—
CcAN lEG1,�ENk
N ch�l N#GG 022023 .•••aY P•••,, DEAPINA MARIE Gll'ENS
Commission No. L� MY e'16,•LO'')0 Commission No. MYCOMtdI� �G022023
.UecRmb
IF putlicUn3ervmte's EXPIRES: _cemt 16,'020
Bonded l'hn hiot2N ',�°:::°e: Bonded Thru Notary PuN it Unde writers
REVIEWS FRON ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 712014