HomeMy WebLinkAboutBuilding Permit Application 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
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Building and Code Regulation Division
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial_ Residential
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PERMIT APPLICATION FOR:
PRC PC+SED INPROVEMEI T I:�.0 JI N
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Address: SSo .�� i��vc, �;. Q�'�-ce. 3�-ii�1
Legal Description:
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Property Tax ID#: 931Q-5o0- 0( 9$� 000 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: I'r
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QETAI[ED DESCRIPTION OF WORK. .�� � nP� �� ��
(��.,,��e - c,�ns 1fiv Lt►o v- fo Feet h►ki.. o vi ez. � I�1-e. y�vo1_11�?uS t /e-I el- t_�
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Additionalwork to be performed un er.t is permit-check all that appy: I
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator f _Roof Pitch
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: .—Sewer —Septic j Building Height:
9111I�IER/I.ESSEE� � CONTRAGTOR� gg
Name . Kol^ vv%Ic Name:
Address: �n-V2S i�.� �ve .: ...
City: State:_ "Addressi''
Zip Code: 1yqot S I Fax: City: State:
Phone No.. qvx'- 905' 3c'!�'®J 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.
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SUP`PME1TaCC4 T UCTI{ N IN IN 'QRMATIC}N: � f51.
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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 Associationrules,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 l 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
improvem is to your erty. A Notice of Commencement must be recorded and posted on the jobsite
before th ft st inspecti n If you intend to obtain financing, consult with lender or an attorney before
comment n work or r c rdin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFA— COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this k.day of Nq.!?E ,20 by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
Si t re of Notary Public- tate of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identific tion Type of Identification
Produced V D�o Produced
Commission No. ` '(Se I11 Commission No. (Seal)
LAs HNA IN"
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��Ppv Pu°�:�•, Notary Public state of Flat
. MY °mints io #FF 177249
REVIEWS FRO,ToX =NINt,�' UR,. ,.1l C ^ . PLANS VEGETATION SEA TO MANGROVE
COU ERr�°1�;12E ►hrou h "RENEE' REVIEW' REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014