HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q �-1 r
Date: Permit Number: 1 D o 3-0" 1(0fi`I
Building Permit Application.
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
PI one: (772)462-1553 Fax: (772)462-1578 Commercial .Residential
PERMIT APPLICATION FOR:
P:ftC}POS+SEDrINPkC}V;'E;M�EN LOCATION
Address: 019 bU tLl-! /�kI IS
Legal Description:
Property Tax ID It: 'S41SEM nn)s� 0008 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
bETAIL D QESCRIPI"ION$C3I= WORK:
F
z
CC�NSTaUCTiOfiI INFO
RM s`
Additionalwork to be performed under this permit-checR all that appy.
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft'of Construction: Sq. Ft.of First Floor:
Cost-.of Construction:$ 1 as Utilities: —Sewer _Septic Building Height:
0111NER/LESSEE: CC±IVTRAC 'OR..
Name. �THE -� eS Name:
Address: / ( � Company: `-
City: <,40 MZ- T State: AddressIbS J N) JtH
Zip code: Fax: City: I S Stater
Phone No. Zip Code: ��)9 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail l,�M. PC7 � � �' T'' P)
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 CONSTRUCTION LIEN LAIN IN,FOR11lIA 7100
P
,a
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
co ncing work or/fZpWing your Notice of Commenceme t.
4 (A
Si ature of Owner/Lessee/Contractor as Agent for Owner Si nature of ContractorTicense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF 1.�,�_„ COUNTY OF S_+.1.►�J
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this@.day of Ylng�„� ,20_a by this day of mQrit k 20ll'�by
(Name of person acknowledging) (Name of person acknowledging)
13b�
(Signature of Notary Public-State of Florida) (Signtr&re of Notary Public-S&te of Florida)
Personally KnownPYoduce`d'Idrati Personally Known ced,ldentification
A.Ry P'�4 LkJFiH I H IV
�
Type of Identificati ` o,P "B.;•., Public Type of Identificationl! LAst'ay,^a�. A aft,
Produced =2° i`°: Notary, ub is-State o1 Florida rNGRAM
M! Produced ""V' 11
t. _ np„!nmm E:;pires Dec 20,.20113 Ry
Gommissicn ,- FF 177249 t�= SI ANNA r��R
F °° ' Commission No. - Seal AM
Commission No. 1 Son(W throl(Seal)�nml Notary Assn. „• ( ) r
of Flora;
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED. \
DATE
COMPLETED
ev.