HomeMy WebLinkAboutBuilding Permit Application i
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All APPLICABLE INFO MUST BE COMPLETED_ FOR APPLICATION TO BE ACCEPTED'
Date: Permit Number:
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! Building Permit Application
Planning and Development Services
Building and Code Regulation Division i
2300 Virginia Avenue, Fort Pierce FL 34982 I /
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential r�
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PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LQCATION '
EM ENT
Address: ' ,I a/6n:5
Legal Description: S{te(q41`0') Z Ci
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Property Tax ID#: /yL3(:2 - ?'0S --Ob&9 000 J2— i Lot No.
Site Plan Name: I Block No.
.Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTIQN (3F W4RK ;, { �.-
YV!l��e r 1 e ✓! !Si n
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CQNSTRUCTION INFQRII/IATIQ',N F ;7
Additional work to be performed, under this permit-check all that apply: I
_Mechanical _Gas Tank -Gas Piping _Shutters' Windows/Doors
_Electric _Plumbing _Sprinklers _Generator -befoof J� Z Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor': I
Cost of Construction.$ 0�5�00- Utilities: —Sewer _Septic Building Height:
011VNERfLESSEE r 'a. CONTRACTQR ° k
Name 4�nn,e, M 11/10.m /,II ran fVame=``�` ' I
r 1Y.f1.
Address: // 7 17:ev..0 5h- �� -� Company:
City: •►7��(�'e State:FL- Address:
I Zip Code: 3�9 y� Fax: City: i' i State:
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail '
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. i
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Sl1PPLENtENTAL CONSTRUCTIQNhCIEN LAW tNFQRtiltATtQN:
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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 recordiinj our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA , STATE OF FLORID
COUNTY OF � �, COUNTY OF
c .
The forgoing instrument was acknowledged before me The forgoing instru nt was acknowledged before me
this day of V: 20A2 by thiso day of 201 by
&cL-ny�c� �'Mc-
(Na of person acknowledging) (Name of person acknowledging)
—ISignatu a of Notary Public-Stafb of Florida) (Sig u4—of Notary Public-Stat of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced =-rA�NA I okm
`�V State of Florida
ASjiAHNA INtiRAM °a""'e publ
""""� tJl -State of Florida ;tP Y P" %; Notary )Dec 20,2098
Commission No. Nota�a'�lic Commission No. ;° Comm. eE
2018 177249
M Comm.Expires Dec 20, - +'E y
+'- y �; FF 177249 :�Nrq+ Commi us h��aonzl Notary Assn.
o�ta �,.ndor, ry ASS
REVIEWS FRO "ZONING SUPERVISOR PLANS VEGETA I SEA TURTLE . MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014