HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED )8-Dy.
Date: 41 ZS /[cF Permit Number: 073 -5
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• — .111N11.111111111 Building Permit Application Penn/tun goe�ia
,Planning and Development Services Eyre.cou tvent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
1.0"/'.
Phone:.(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address: / 6 c /y ,co
Legal Description:
Property Tax ID#: Zit O(D • 5-57- ° C) 1 9 '7 • 0 co ' 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: .
DETAILEDDESCRIPTION OF WORK 'Mt
:,i---it,tvt- eg--2(__ i'''4,e k / /
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all that apply:
_Mechanical _G's Tank _Gas Piping _Shutters - .. —Windows/Doors.
_Electric Plumbing _Sprinklers _Generator _Roof • Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: , 1
s�4[0 Coa I
Cost of Construction: $ v ' Utilities: _Sewer _Septic Building Height:
OWNER/LESSEE: ..;, CONTRACTOR:
Name XCL-6:r.;..-S.--7-0 al,( L Name:
Address: / ,D k( - �5 /ii Company:
City: f,eP,(� State: :. Address:
Zip Code: 3y g� Fax: City: • State:
Phone No. I Za /— 3 4 9' " "Z 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,
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 plan's,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.
Signatu e of Own /Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA __ -- __ STATE OF FLORIDA
COUNTY OF %S aa", G.0 432-. COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this ?.$ day of P ri I ,20(Sr. by this day of ,20_ by
Le- I I a J D 1,t1s 6-Y1 5 A,r v\4-2
(Nam- .f person acknowledging) (Name of person acknowledging)
(Si: at re of Notary Public- ate . Florida) (Signature of Notary Public-State of Florida)
•ersonally Known OR Produced Identification Personally Known OR Produced Identification
Type of Idptificat-�^ .' Type of Identification
Produced 1r1— l Produced
Commission No. (Seal.)I nHj A iNGR_AM i G mmission No. (Seal)
=2 - n;,`�\, �lotary Public-State o(,.Jo c
•=My.Comm.Expirss,,pe2pr
ComiNssion fFFf7i.A%4•
OF FSO
REVIEWS FRONT, IN ,ed dttrogvt REt _ Ir i LANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW.' RE •EVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Zev. 7/2014