HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -t
Date: Y;�L,\'4�� \n Permit Number: 1 �+"'015 y
Building Permit Application DEC 2 9 1011
Planning and Development Services
Building and Code Regulation Division �p�
2300 Virginia Avenue, Fort Pierce FL 34982 ' """........
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
To Select from dropbox, click arrow at the end of line Q'- 1"iJOf_
PROPOSED IMPROVEMENT LOCATION:
Address: ve(+
Legal Description: LoZ" L 'tGt S R-►9+ N10. C' JF b2 I OFA•� ,��
Property Tax ID#: 3L-a t o - qoc ) - C C)u a - Ooo- 1 Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
r r r.,`_%'L -e,6S'I'rn5 rJoF dawn l-1 fl%�v wo,-a. 12 IJ�c 1 Flo lr15{a11 3l/1�7
�� �(1-Pl {-� c�d..2 _ f,n S E�t I 35�r K�rc•h..I-c c,}�,,•� ��n�1.(n � G�LQ .
CONSTRUCTION INFORMATION:
Additionalworkto oee_ner�tormed un �thispermit-c ec a appy: __J
HVAC nk Gas Piping _Shutters F Windows/Doors
Electric ❑ Plumbing EJ Sprinklers Generator _Roof �J / Roof pitch
Total Sq. Ft of Construction: ✓a S . Ft.of First Floor:
Cost of Construction:$ /�J ; Utilities: Sewer Septic Building Height:
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OWN ER/LESSEE: CONTRACTOR:
Name JPSWhru 124-� Name: C (tl rn
Address: CAiz Company: O
City: -hor+ IMC i C State: ( Address: StivV
Zip Code: 34'gq)_ Fax: City:190a hUJCi L State:
Phone No. l rI,).-- 3`4 6 - �( Z;Lp Le' 1+1Zip Code: +1 b _I Fax: '_1 rl�
r7-?d-
Orj-'735�
E-Mail: Phone No. / �a - 3L-M- I Cj
Fill in fee simple Title Holder on next page(if different E-Mail:5�- U-6 OO-F,n tL q O r"
from the Owner listed above) State or County License: C 1
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 thepermit 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
commencing work or recording our Notice of Commencement.
— _4_t� - —
Signature o O ner/Lessee/Contractor as Agent for Owner Signatuof ontractor/License Holder
STATE OF STATE OF FLOR
COUNTY OF ORID,i�; COUNTY OF tI kXA Cj,"—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-�`J day of De C 20 (9by this_j:2tA day of D'c .20- by
Name of person king statement Name of pers aking statement
Personally Known��OR Produced Identification Personally Known �OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Not -5tate.of Florida _ (Signature of Notary Public-State of Florida)
ONSTANCIaE PROULX
Commission No. 1 .: +�OMMISST�N Commission No. tt
y. FF 160517 ._ STANC OUL
•, a. EXPIRES September 16,2018 ' MY COMMISSIOn; 4!FF 7605
(407)39MIS3 Flwndalloaa Servioe.00rn ••�.�, EXPIRES
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA T ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17