HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z 2 I ` Z C7/(. , Permit Number: 4_0 VI
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Cala. lr
F L O R 1. D AFIL
Building Permit Application
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: W,Nhav0s
R@IiIN�PRc1VAT fLOCAdTION • ''. n : x .
Address: .30?0 /qO eoe5
FxPivefi. ( 2,V9E (
Legal Description: .5 2c0 (27 /
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PropertyTaxlD#: 24130 —in— Cakt— (7UU -v Lot No.
Site Plan Name: Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAI°LED D SGR�IPTI®N @F WORK 41.0.e-%4'441.-"c44,47.,:-.:"..,44,4 •
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WS
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C®`NSTRUCTIDN �N F®RIVIATI;®N� � - :.::. .. ra Y t
Additional work to-be performed under this permit—check all that apply: • jj,•
_Mechanical _Gas Tank _Gas Piping • Shutters �V1%iridows/Doors '
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: • Sq. Ft. of First Floor: ' _
Cost of Construction: $_20 Utilities: Sewer _Septic Building Height:
OUVNER/LE�S�SEE y CO`NTRA//��C.• 1,0 . _... ._ 5 ¢ age
Name S�lVty'j'Ore.., c/rc Iq-/!ic-��U Name tindlre4x> Ca(ns i-e-
Address:, .307.0 , a d. _ Company: I [ l4 � ';t p 1✓lc.o
City: Z State:A Address: 4� �
Zip Code: 309E3/ Fax: City: State: ,_
Phone No. 771 2 3 3 - l 3?( Zip Code: ?(7L g"/ Fax:
E-Mail: Phone No 77Z 33Z 133/
Fill in fee simple Title Holder on next page( if different E-Mail AC 1'4 ° 2kA{ fC:1-66/14
from the Owner listed above) State or County License C I oc''g B3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S mpLE1111ENTAL C®NSTRRU�CTI®N LIEN LAW INF_ORIVIATIQ�No, - e:'I-4:--4',::: 54 ';=-"--'.'4',"- .=�
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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 your Notice of Commencement.
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Signature of Owner/Le ee/Contractor as Agent for Owner Signature of Contractor/License Holder. . .
STATE OF FLORID y STATE OF FLORIDA,
4-2_
OF "1 Lu.CA' e COUNTY OF ' '-. Lu 0.t_C._.
The forgoing instrument was acknowledged before me Th for ung instrr ent was acknowledge before me
this2:1 ay of innttcw ,20 Icc by this day of ioCUCL&_ , 20%S by
Amcrei C rim e ooi "_ .Al l's i:v Ccimeci e
(Name of person acknowledging) \J 1 (Name of person acknowledging)
(1 AA. rye_-_ ' ri /1 fes. . AA
S�e of NotaryPublic-State of Florida
ure of NotaryPublic-.State of Florida
( g ) (Signa )
Personally Known OR Produced Identification Personally Known OR Produced Identification ���1J1
Type of Identification Type of Identification
Produced 1o';