HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED y `
Date: •� )°� Permit Number: / -q c 1 oSq
Building Permit Application
Planning and Development Services
Building.and Code Regulation Division JAN 2` 201
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential C/
PERMIT APPLICATION FOR:
P.rtROPOSED IN.PROVEMENTn,LOCATION j j
Address: /�- �14 D 0 O S . , L[� Q 3 K5z
Legal Description:
Property Tax ID#: _3Y / L/-- SD )— 1`7 0 I " 0 L? 0.0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
QETAIl.ED DESCRIP�'ION,OF, OR
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CONSTRUCTION INFORMATION
Additional work to be pertormed under this permit-c ec a that apply-
Mechanical
pp y-Mechanical _Gas Tank _Gas Piping Shutters _Windows Doors
_Electric _Plumbing _Sprinklers Generator _Roofer Pitch
Total Sq. Ft of Construction: )-700 Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: _Sewer'_ _Septic Building Height:
OU1tNER/LESSEE CQNTRACTOR r
Name lep6q L-l & Name: -o z C7G`
Address: 3 129? ' &OV 0 Company: Za ��—
City: b�� ( GlOL(� State:� Address: C-Z SG C�l�-/�rU !��
Zip,Code: Fax: j City: 2 .S/ 211Lec' State:,ff*
Phone No. ('-� 7 moo) So Zip Code: 2?,95ZFax:
E-Mail: Phone No -7
Fill in fee simple Title Holder on next page (if different E-Mail [a )) e tj f-nfr- Ld"LQ
from the Owner listed above) State or County License o2 qCQ:zz
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SU,PPLEIVIENTAICONSTRUCTION LIEN LAIN INFQRII%IATIQN
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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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA �' STATE OF FLORIDA y�
COUNTY OF l COUNTY OF 9�✓� wvlJ
The forming instr ent was acknowledg ,r The f ging instr ent was acknowledg; efor
this day of 20 �= this day of 20 by
(Name of person acknowledging) (Name of person acknowledging) a X
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(Signature of N ary Public-State of FI rid[tIffiA
A (Signature of tart'Public-State of lorid �T s
Personally Known OR Produced Idtion Personally Knowra.-- OR Produced Identificati
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. 7/2014