HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE_COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:^ —�—j Permit N 'mber:'J OOO Ott' Ow 7
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
I
PERMIT APPLICATION FOR:
PRC?PO ¢E® }�a rU�lEME t�CATN: _
�.0
Address: d� �
Legal Description:
Property Tax ID#: we> olll Dbb 1 Lot No.
Site Plan Name: ; Block No.
I
P roject Name:
i
Setbacks Front Back: Right Side: Left Side:
�
®��AILkWfl ED D�►�R1�?�Tl®N �F U1/®R{ �_ � � �`�,I'� � I � �
.
i
Ge- U .IOW! ,4AJEL Q m
zea �� � �
� g 4 ��{
n
Additional work to beperorme under this permit—cec all that apply:
_Mechanical =Gas Tank _Gas Piping _Shutters _! Windows/Doors
/Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction_: Sq. Ft.of First Floor: s
Cost of Construction: $ /i 'o Utilities: Sewer, +_Septic Building Height:
r RCONT g
E
t* /11/ CdC
Name:
r
s Address: � �S Company: DIV C�A�cIA ON G r -
City: State: hL Address: (2 l ) 1A fF
- ,, State:�L
�. 'Zip:Code: Far. City: I'LLcC/
t phone No.-- qzy' /7-04 Zip Code:J'00
E--Mail: Phone N6:y7.2-`nof- c �°
Fill in fee simple Title Holder on next page (if different E-Mail
9��1404 . o/K
from the Owner listed above) State or County License ;, JDAD?
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ;' '
SUPPLEMfNTAI.CO.NSl"RUCTI®N LIEN I ►W 1NFORMAT(®'N
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/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST• (AuC ICOUNTY OF Sfi L..'A«'L�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20ig by this �day of 20L by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florio (Signature of Notary Public- a e of Flon a
�`S • N•
Personally Known OR Produced Id Personally Known_v--'OR Produced Ident' is
Type of Identification Type of Identification =r •.;,
Produced "'� Produced - `=
09 n6 0 0 ; Commission No.
Commission No.;< < `� (Se I)3 �O t(.fXc l (Sea � o�
o
'- � 37
REVIEWS FRONT ZONING �l als f R PLANS VEGETATION SEA TURTLE M 11
COUNTER REVIEW oi�EgliIV . REVIEW REVIEW REVIEWy a
DATE
O (j1 °'
T
Q, NO O OT��A fD m
RECEIVED U30 N s
DATE ^il
!O Cyi N O
COMPLETED
w.
lev. 7/2014