HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1/�
Date: Permit Number: B 0z-OX"( .
� r F
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 V/a _S
PERMIT APPLICATION FOR:
PROPOSED INPRQVEMElT LQCA IOV
�
Address: 1�0 (Zq S, IVey2 0A l a
Legal Description: e V\ C '�
Property Tax ID#: 410 2, 611n - O a- t _7— y D O:� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: ✓ Right Side: Left Side:
DEl"AtLED DESCRIPTION aF WORK
Wooc n-r 'e Vic cf D
ICQNSTRUCTtdN FOR
Additional
�., c W � .• �.:. . . ..
workto a pe orme under this permit- ec a tat.appy:
._Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _.Generator, _Roof Pitch
Total S Ft of Construction: Z- T
Sq. f � Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: . _Sewer _Septic Building Height:
OI N 0VLESS ' CONTRACTOR
Name U ( I Name:
Address: S t,O q S 1'k le V OV-1 f': l2 Company:
Citv: anti lNe'RC -e- State: EL //1 Address:
Zip Code: 3 y ci' 7 Fax: City: State:
Phone No. �/(�? Q -3 L) •- 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.
SUPPLEMENTAL-CQLIEN LAIN I.NFORIVIATIO[V
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.
47
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDtk
STATE OF FLORIDA
COUNTY OF . ' = COUNTY OF
The for o' g instru nt was acknowledge efor m�"""" The forgoing instrument was acknowledged before me
this day of 7¢74}—.,20by m5 this day of- 20_ by
�o
z
Mg9
(Name of person acknowledging) 8 a (Name of person acknowledging)
C pNN T2 m
1���1�'��`Fi- - � • to IV
a
(Signature of Wtary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific�tt n /�\ Type of Identification
Produced . •.J�-�. Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ) �J. Permit Number: B a a-
27.
t
� I
r •
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 V•e S
PERMIT APPLICATION FOR: &Y)
PROPosD INaPRQVEMENT.LOCA. ION ''nn
Address: ,)O a g S► I V e a Ute I: V i2
Legal Description: Fe V\ c e
Property Tax ID#: I Z (' fP 6 cn - � � 1 _�— d� f�:� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i.
4
DETAIL DESCRIPTION QE 1JVORK
GQN5TRUCTION INFORMATION-
a
Additional work to bepe orme under this -check all ' _
_Mechanical _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:$ Utilities: . _Sewer Septic Building Height:
DINNER/LESSEE
TO' R" ,
V�IZ� L (
NameM_t �4-lZ KName:`� I '
Address: S 0 q' S i'kIf V L v-1 t, 12 Company:
City: (--mtt 161•eR State: EL !/1 Address_:
Zip Code: 3 1/cl q 7 Fax: City: State:
Phone No. )-14, - V -3 q 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.