HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:a Permit Number:���O�"
•
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 Z.X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: _Atm C4Roll£. ,nl< (I
Property Tax ID#: _3'4k? ,5o3 ov2Z 000 Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
?LA C, Arte Fu ,�qPlI Yc. w 51. s KJJ :NCA;
CONSTRUCTION INFORMATION:
itio wor to e e orme under this permit-check a apply.--
HVAC
ppy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric F] Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities:0 Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name c,8= U): L )5 Name: TilC'NA R9 A. VV4L a k
Address:_�43ct P'LAVELCKS tyn-I Company: COLD r2c:MCJ Y 4& INC
City: State:fl Address: 6,33 /QE 4/J
Zip Code: n Fax: City: TggT Sf Lv`I L_ Stater
Phone No. -2/443- Zip Code: �_4gF,3 Fax:
E-Mail: Phone No. T711 4VI L a16y'
Fill in fee simple Title Holder on next page(if different E-Mail: &J la L IKA ILLY l
from the Owner listed above) State or County License: Cl LAI S (2,�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
.ni..n. .i• .• I.. Iu...—..,moi u. . i.i .w •, ...t ..wu1!n. I1P1 •
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
commencing work or recording our Notice of Commencement.
Z-1 _..
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5A-. I- yc Vic'. COUNTY OF `--A .). , c,t
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledgej before me
this day of`� Xx_ , 20A by this K day of 201by
R: %-,4-( a \)10 \ k 4�-r� I K"<'1ti0,< 4► 3 cS1 k d P--)v
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-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 Identificatio
Produced uced V�_ MARIE GIVENS
..>.s.
^' NAh1ARlE GNEN MY COMMISSION#GG 022023
Commission No. 5�1 YP $eCOMIJ+ISSION#GGO 0 ission No. EXPIRES:��r16.2020
:December 16,2 -0.
Bonded Thru Notary Public Underwriters
PIRES i iters k, \••'
l=+ P
Bonded
Thru Notary Public Und
REVIEWS FRONT ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014