HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED � j (CODate: Permit Number: I 0 p1�� • OtE'`f��>
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Planning and Development Services ,gyp
Building and Code Regulation Divisio�i R ��208
2300 Virginia Avenue,Fort Pierce FL 34982 pP,rwttin o
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentico
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENTLOCATION
Address: 33 fUo ''-)- /. nil. S 1" FO r-4- Pi' rCe r` ve-
Legal Description:
Property Tax ID#: —10 3• • Og 0c). O 9 v Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: 4/d ' Left Side: .:3
DETAILED DESCRIPTION OF WORK. ''
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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/Doors
—Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ . I l S Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name l e_L � /1" f c Name: ()y' — ' �' -ee vv.Ir.._
Address: 3 . I u- , 5* Company: :. Ei-� .1.U k-i Pt) I CSO /n54-v-Uc' i 0
" ICity: .,-2),--71" i ° ^Ce Stater1- Address: uqb7 ��.5Si Gk �ot+ ��rCP
Zip Code: 3 d` 'mac- Fax: City: FO-rj" ?i'ErCe State: 11,4
Phone No. Zip Code: 3 '! Ci $rte Fax:
E-Mail: Phone No '207j 9 4/O " a. 1,
Fill in fee simple Title Holder on next page(if different E-Mail Or-r,(e_ �f n, n LT') a_9 1710., /a entvt
from the Owner listed above) State or County License Cv u r\ I-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
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
corn ing work or reco ing your Notice of Commenceme .
........r....
Si nature o Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S -Ind,�, COUNTY OF $.Let
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Q,i1.A_3 , 20_ by this.. .day of Ot.+,.,.9 ,20h$ by
(Name of person acknowledging) (Name of person acknowledging)
&•••110•4;4_.‘,..N.,..,.
re of Notary Public=State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Sell • Commission No. (Seal)
9�- ~� A INGRAM RANI c _
���„ LAS lorida �_.:•..--.�-.-- -- - 1 • .-.
"\�clotaty �� »c,20,20'3• d a c is-Sultf 0 '
REVIEWS FR..t;---7—:Ac'''
NT*l "' ONING : SUPERVI }OR PLANS VEGETATION` SEA,TURTLE a iffA IGi'iiVE
COUNTER' I'EVIEW ''REVIEWS REVIEW REVIEW TSF 3REVIEW ') ' FI REygw
DATE ,„ "n non^e�. u,u•,s; .,r ;w,'- ,�
I
RECEIVED =
DATE
COMPLETED
1ev.7/2014