HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LlO
Address:
Legal Description:
_
Property Tax ID #: So I - Lp I t _ o-1 5 - o c' , 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
V -r - � I t VLE S ±pry I
C STRUCTION INFORMATION.
Additional worK to e performed under this permit- c ee�i� Ta(l that appy:
`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: $ 3o)00 00 Utilities: —Sewer _Septic Building Height:
OWNER S ;E._
Name�.�G�Gf�
CANT uCTQR;
Name:fj:)uC� lzx�t�C�
Address: � t
Company:C&D l A\rr -'-�blu+ S of RL, 1n
City: Fof(t P 1 of CCS State:
Zip Code: 3q 31,5 I Fax:
��
�- _
Phone No.�
Address: [ p 9Q-3 Cr c a-,ic- I-aoc- - - —
City: C-4 Our-!- State:
�l 53
Zip Code: :..3�"15 d� Fax:'/ 1r�- ����9
Phone No I --
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License C AC I �K 19col�
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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 thepermit 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
commencina work or recordinR vour Notice of Commencement.
�A-Z
DESIGNER/ENGINEER:'
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
STATE OF FLORIDA
COUNTY OF S L- uc
Name:
Address:
a
Address:
City:
State:
City: State:
Zip: Phone
(Signature of otary Public- State of Florida }
Zip: Phone:
Personally Known OR Produced Identification
Type of Identifie tion Stephanie Mou
r@roduced et— L r5teph nNOTARY PUBrNOTARY
LIC 73 + _STATE OF FLCommission
0�� nission No. ! z G FF957omm#
38'1 S�+YCEt�1Expires 21412
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
REVIEWS
City:
Zip: Phone:
SUPERVISOR
REVIEW
Zip: Phone:
VEGETATION
REVIEW
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 thepermit 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
commencina work or recordinR vour Notice of Commencement.
Rev. //ZU14
Signature orf Contractor/L' n e Holder
Signature of Owner/ Lesse6aorrtfactor as Agent for Owner
STATE OF FLORIDA
COUNTY OF LOC- {'
STATE OF FLORIDA
COUNTY OF S L- uc
The forgoing instrument was acknowledged before me
this day of 20� by
The for oing instru ent was acknowledged before me
this day of GI'7 20� by
a
sh A An Wo I+ CZ0�-
(Name a0person acknowledging }
(Name of 4rson acknowledging }
(Signature of Not ry Public- State of Florida }
(Signature of otary Public- State of Florida }
Personally Known OR Produced IdentificatiooX
Type of Identification
Produced 'U:-- L- DI VY anis M
PU
No.F -15733STATE aF F
FF95
Personally Known OR Produced Identification
Type of Identifie tion Stephanie Mou
r@roduced et— L r5teph nNOTARY PUBrNOTARY
LIC 73 + _STATE OF FLCommission
0�� nission No. ! z G FF957omm#
38'1 S�+YCEt�1Expires 21412
pnim% 911.0020
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //ZU14