HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: - Permit Number:
Building Permit Application FEB 7 2
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:
OR,aPQS'b tNPROVEMENT 'ATN N„o e.
Address: eq- ke PO S C9 -
Legal Description:
Property Tax ID#: I / - /S� 3`0 `00o - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
E
DEl`Al[ED DESCR#PION OF WQRK tiR '
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CONSTRUCTION INFORMATION 3
Additional wor to be pertormed under this permit-c ec all t,at apply:-,
I&IMechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
Electric _Plumbing _Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 3 Utilities: -Sewer Septic Building Height:
01INER/LESSEE CONl`RACTOR. 50
. .
Name v le-1 1 1r Name: Da VI
Address: &,cC 6eg Company: -Sop
City: 10 zt V 41 State: Address: D
Zip Code: � Fax: City: PDC 1 I State: //�� AA
`91626
Phone No.. 2 • S Zip Code: SoZ. Fax:
E-Mail: I!'1 b Phone No - ol W
Fill in fee simple Title Holder on next page( if different E-Mail SG ` vc-' -
from the Owner listed above) State or County License C C
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN' 1N ORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 Signa ure of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF F941
cli
V
The for oing roofs ent was acknowledge bef r The fo going instrume t was JcknowledTe
this day of 20�b �� this I day of QFLDa/)' 0
(Name of person acknowledging) x (�LLName of person acknowledgi ;'2..:Vot�
ao.
ov
(Signature of N t ry ublic-S ate of Flori ) g. d4 (Signature of N to Public-State of Florida)
Personally_Known OR Produced Idents Personally Kn OR Produced Identificatiom'
Type of Id if'c tion Type of Identificati _
Produced - r Produced '
Commissio o. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014