HomeMy WebLinkAboutBuilding Permit Application I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q f�
Date: Permit N Imber:�
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 I Residential
PERMIT APPLICATION FOR: Ci
PRC1P�05ED INRtf�1lEMENT La'CATI7t � , i .
Address: J c� �D D S -C) t �l CLQ ' - �; p-
C)
Igal Description:
^� C
Property Tax ID#. U6 op,5A- om I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
pF�"l A1l,ED IPTt01Y C7F WORK y d gg
., .,..
d
� r
s e _
o Ca_AQ- ) —
/ e_ Ct eQ__
CONSTRUCTION 1NFORMAT104Nr
y.
Additionalwor eto be pertormed under t is permit-checK all tat appy:
_Mechanical _Gas'Tank _Gas Piping _Shutter) ,; ; Windows/Doors
1V Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$S Utilities: —Sewer —Septic Building Height:
01NNER/LESSEE, >, CONTRA'-IT
Name Q. Koa 0 CL Name: L GCIA
ddress: `0! �(��L v? 5 oy7 S4- Company: C L_j e,:-1 L
r
City: State:_ Address: 13 1 1 CL�`y� #� X
'Zip Code: Fax: City: I&VI", IJ'o-o &Lx'//I Stater
Phone No. Zip Code: 4L'3 C' Fax: S61-7 Saba?
E-Mail: Phone No d,&
Fill in fee simple Title Holder on next page(if different E-Mail n -I -[
from the Owner listed above) State.or County License ! �Cp
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. '
i
SUPPLEiVIENTAL CONSTRUCTION LIEN LAW (NFORMAT(ON•
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 a A for Owner Signature of Contractor/License Holder C--
STATE OF FLORIDA STATE OF FLORIDA.
COUNTY OF COUNTY OF S�13.1-k-:9—
The forgoing instrument was acknowledged before me ThefoQr�going instrument was acknowledged before me
this JC day of d 20-U by this "� day of d ,20_1i�_ by
t
(Name of person acknowledging U (Name of person acknowledging)
(Signature of Notary Public-State bf Florida) (Signature of Notary Public-S to of Florida)
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
:Ie—v.7/2014