HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE(INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: J �f6 Permit Number: D [)) - osl (D
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Building Permit Application
Planning and Development Services
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:
41-4
PRQPi*0 4404 ALC CATlO V
Address: c,c, S [-
Legal Description:
Property Tax ID#: 3 701- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
aETAII.ED oSCRIPTION of woRlc� y
.B ., � t . .: �.<
LJ -PSN a0,17
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�O STRUTICN INPORIVIA 'ION41
Add,Iti.onaj wor to be pertormed under this permit-checkiall.that appy:
y
_Mechanical —Gas.Tank _Gas Piping?: ShuttersWindows/Doors
Electric _Plumbing _Sprinklers' Generator 7Roof Pitch
Total Sq:;Ft of Construction: . . r kU o " Sq:'Ft.-of First Floor:
Cost of Construction:$ U C2 Utilities: _Sewer _Septic Building Height:
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OUIiNER/I;�SSE _ CONTRA " R• a _
Name iN r' Name: Ia,t'l,,w y
Address: 7Ub ��. r/1 1�G� �fi Company:
City: State: i Address: X0 G
Zip Code: Fax: City: �I- — Stater
Phone No. Zip Code: -3 �' Fax:
E-Mail: Phone No 2 fid- U-07 3,
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License CLC 132—L
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION'LIEN LAWINF(3.RMATIQN
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 wit der or an attorney before
commencing work r recording our Notice of Commencement.
"Al
Signature / er/ see/Contractor as Agent f Signatu ntractor/License Holder
STATE O LORIDA _ ��' STATE F FLORID .
COUN F �R COU OF
The forgoing instru ent was acknowledged before 9:11 j The forgoing instru nt was acknowlecig efor 1K,
this of 20L�y pw this odd day of iia 20_ by z
46h 1AA_A 0 LAA
coal
(Name of pe on acknowl ging) " °d�. (Name of persona owlQ'ing
4;4'Za4
Signature ofAlotary Public-State of Florid (Signature of/Notary Pu lic-Sta of Flor' a)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.