HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J `
Date: �' ) Permit Number:
7AP:RO
EIVED
Building Permit Applicati n
Planning and Development Services 3 20%Building and Code Regulation Division2300 Virginia Avenue, Fort Pierce FL 34982 ST. Lunty, ermitting
Phone: (772)462-1553 Fax: (772)462-1578 Commerdal Residential
PERMIT APPLICATION FOR: I
PROPOSED INPROVEMENT LOCATION:
Address: 2 . P.
- L L
Legal Description: G;poem F— Coves ��0- Sa e—T DI's l '— Lz ^JJ0C)
Property Tax ID#: Of 4 SD Lot No.
Site Plan Name: Pr I G`2—. Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CN v3 K(t,wtio oL A 6T_ L 't4-
CONSTRUCTION INFORMATION: j
Additional work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
n!U rn L.'n.g C klGenerator Rnnf
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
vv
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
CONTRACTOR:
Name CR(Z( l Rh I(=WIC. Name: bNV 6 (Y\A,2S�4AL.c.
Address: LIl $;4AS161K, ftK- Company: 6W!!O A. lhA/4RA C4_ , �r.G, /"'c--
City: C A ic 14 State:J�— Address: 1 tiL y O e' �_
Zip Code: Ga L3 U FaxCity: bo- ! E State:
Phone No. R74!Y440— / 33 73 Zip Code: 3:31 2-1) 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 G G-C O S-G7
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU, N LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Ivame: IVdIIIC.
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.
Si. LUL!'e cuunt 'lwkes no representation that is granting:p c.—r,..!t will author'_-the permit holder to build the subiect structure
which is in contIict 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.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this �J day of S f 20j by
c M4(c,,kc\, I. 1
(Name of person acknowledging) (Name of pe on acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known O P oduc d Identification
Type of Identification Type of Identification ����� „�� BEVERLY D.MARSHALL
Produced Produced ` 00k•$We of Florida
GG 05'7Y3 i = Com"096ton•GG 057931
Commission No. (Seal) Commission No. My C0404wel Jan!,2021
� 111011"MMouoA ffM 181 NODWI Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014