HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h J
Date: l ��� l� Permit Number:
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Building Permit Applicatiogn 1;5. 2010
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:
PRt05EQ IN.hR01lEMENT,LOCATION.
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Address: `��Z 1 dbi►�S i 6ys- S► f - -e ✓LSL :;77f-• 3 q,9 9 7
Legal Description:
Property Tax ID#: 3 ' 2 - b os- nob -- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILE[3 QECRIPTION aF WORK
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CONSTRUCTIONgINFOAM' ION• z 'g
Additional to e e orme un er t is permit-check all that apply:
Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers: ., _Generator _Roof Pitch
Total ScliTt,of.�Construction: Sq:'Ft. of First Floor:
Cost of Construction:$ 25M Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE. C R.
ONTRACTO
Name . Cl, Vl IK Name: Ct
Address: �'� Company: e '
7 �dln�S 0-\ _
City: 7' ' 73 12 LQ_ State: - Address: r c)
Zip Code: 3 49'S Z Fax: // City: Stater
Phone No. -3 7 2 Pqo-- [O U LA Zip Code: (O Fax:
E-Mail: Phone No :7`7 2 - .4 U �' - 7 U 9== 2—
Fill
Fill in fee simple Title Holder on next page(if different E-Mail .C
from the Owner listed above) State or County License cf ($/ 7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPRLEMENTAL CQNSTRUCTlON LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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
commp-pcing work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Signature of Contractor/License Holder
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STATE OF FLORID STATE OF FLORIDA
COUNTY OF =LLQ. COUNTY OF N
The for ping instrument was acknowledged_before m mN The forgoing instrument was acknowledged bN
this day oM D i 20by !�Uj z this I-day of M -!f 201& =o a
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(Name of person acknowledgingame of person acknowledging)
(Signature of Nd,! ry Public-State of Florida) (Signature of otary Public-State of Florida)
Personally Know OR Produced Identification / Personally Known OR Produced Identification
Type of Identific don Type of Identifi6t or
Produced a �1t- 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
Rev.