HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: Md �,dsa '�
R
ECEIVED
Building Permit ApplicaEonMAR 1Planning and Development Services cie Coun
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: SL
In
Address: 10014 S AD E ' .c' i 1 INS 1)C 1yr-- I)h9 IT A
Legal Description: -�Cl Q p Cc9 0(L %�Q.4Lh, '36C•Ttooi dk)�_
Property Tax ID #: 0;1'0 _ i Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front aj Back: I -5- Right Side: Left Side: 7•
j DETAILED DESCRIPTION OF WORK:rt Y w
/UO Z eft^ T'R f6AL AJo i1g ip
CONSTR
Additional work to be per Orme under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _ Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: !�3tp `j-r Sq. Ft. of First Floor:
Cost of Construction: $ ,�I00 Utilities: _Sewer _Septic Building Height:
Name -kw S K . G ka_W_ A e-A Name: �TC 2
Address: 4 -5RpWfIUbS 42• A Company: rat-�AIOAC
City: State: Address: G!/t
Zip Code: Fax: City: /J/'Q C.9 State:�,1-
Phone No. Zip Code: Y�1 L- Fax:
E-Mail: a Phone No Z 1-160— 446e0
Fill in fee 4ple Titfe"Molder on next page (if ifferent E-Mail 44, tr�QSe,42pAe,15
from the Owner listed above) State or County License
/.•5 6L cc C. (o
If value of construction is 2500 or more, a RECORDED Notice of Commen ement is Fqquired.
SUPPLEMENTAL CONSTRUCTION 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 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.
►'(y ) a (k fA
Signa re of Owner/I
ssee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledge) before me The forgoing instrument was acknowledged before me
this\4 day of `14\q{ 20\ by this day of 20_ by
"Say rnR 'S Erg.a t dna T �C
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P blic-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced D ANNA MARIE GIVENS Produced
g' MY COM dISS10N#GG 022023
Commission No; ;° onded ThWEXPIR De mi uc underwriters Commission X20 Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETED
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