HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE"7IINFO7MUSTT/BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1,- C1(11•101-'
Date: .( ! � r( b Permit Number:
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I cling Pe�nApplication �,��i@oPertment
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: 5j
PROPOSED INPROVEMENT LOCATION
Address: 5`3 y 2 Cee/ Gory"
Legal Description: /
Property Tax ID#: I y r 0- So 2 - 0>f' 9 ?, - 0'00— 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: 5Right Side: Left Side: 5-
DETAILED DESCRIPTION OF WORK
1Veui ''y '
se,t b k fro s
b Fro el.o r Srcts:.(Tic.re. S
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CONSTRUCTION INFORMATION
Additional work to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters • !: Windows/Doofs,•
Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: I 0 Sq. Ft. of First Floor:
Cost of Construction:$ _ ?6.--W- Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR..
Name i►I[ e , � P� -Cc. fr/c ei � Name:
Address: 5. 9 g. �p e I 1,00t-/ Company: •
City: (1- fr p rtP State: *rt. Address:
Zip Code: 3 tf ' WI Fax: City: State:
Phone No. '4'5- GYM - 057-<- .(771-7A•'/6o-5?5,9-- Zip Code: 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
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
/ ApplicableMORTGAGEplc
DESIGNER ENGINEER: _TNot 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.
(4 a— '
igna ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF ( . L va,C., • COUNTY OF
The forgoing instrument as acknowledged before me The forgoing instrument was acknowledged before me
this 11 day of Apol ,20 Re, by this day of ,20_ by
(b✓IOL kV.* /�G —
(Name of person acknowledging) (Name of person acknowledging)
'_n.ure of Notary Public-St- e of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification\, Personally Known OR Produced Identification
Type of IdentificationType of Identification
Produced V}Z303 l.'}�@Q Produced
Commission No. v -- ._ Commission No. (Seal)
,_ § y.•-•7,7 Nota ry I"611'_ Rf
.. PY ,ornm., - .Of lorida
REVIEWS FRONT �1,: ,ZONING Fond°SUPERVISOr. R,, �`�'� NS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW-- ii f y'R'EV/dEW REVIEW/I,
E :EW REVIEW REVIEW REVIEW
DATE - # 1 ., •
r
RECEIVED
DATE
COMPLETED
1ev. 7/2014