HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l — ODq 3' `
Date: �� Permit Numb r
Building Permit Applicati perPR -4
Planning and Development Services St 7�711t,*79 2018
Building and Code Regulation Division 8 L(/cie �epa
23W Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 -Commercial Residen Co e/7
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED.IMPROVEMENT LOCATION
Address: �)kQ I JaME11 //-��
q LA 16o
Legal Description: �i � \ "� Y�;c
Property Tax lD#: ����Dy� ��`{ r� Lot No, 1�
Site Plan Nana: �SU
n V'(S Vea,V'1 J9s _ Block No.�.LL
Project Name: .
Setbacks Front Back: Right Side:= Left Side:
DET AILEDDESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
Additional work toe e rme un ert is permit—check a apply:-'
aHVAC 0_Gas Tank []Gas Piping - _Shutters O Windows/Doors
D
Electric Q.
Plumbing-� OSprinklers E Generator Roof
Total Sq.Ft of Construction: J _ _ .Ft of First Floor:
Cost of Construction:$ Utilities Sewer 0 Septic Building Height:
OWNER/LESSEE CONTRACTOR'`
Name Name: C¢ C
Address• • 1 Company: 1 c C K!�
State:� Address- C rt-- 4 d- -
"Zip Code: ���1GJ� Fax: City: F f�KPi State• �L
Phone No. P Zip Code•,3 LO 6� • Fax: 7 7,)-
E-Mail:
a-E-Mail: Aln Phone No. 4,
Fill in fee simple Tide Holder on next page(if different E-Mail:. Ce eur �d
from the Owner listed above) State or Coun 'cense: a
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'� �,LEMENtI'/A��L�;eO�NSTRUCTON LIENIA� lNFORMA O('�" ��. � �`'
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 herebf 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,screeft room}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,consu with lender or an attorney before
commenpM work or recording our Notice of Commencemen .
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAr STATE OF FLORIDA). ��
�rN
COUNTY OF f C COUNTY OF 7'
S24%-
The forgoing instr ent Was acknowledgjQefore =LL The forgoing instru ent was acknowledge, a Z
this r day of 201 0 by this day o 20' 0 oa
x bio a bu c
00
(Name of person acknowledging) (Name of person acknowledging)191, ;fir
` :M
( ignature of ary ublic-State of Flori a) ,(Signature of Notaryblic-State of Florida)
Personally Known� OR Produced Identification Personally Known e_/011 Produced Identification
Type of Identification Type of identification
Produced 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
ev.