HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE(INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 Resid'e'ntial
PERMIT APPLICATION FOR:
PROPOSED I,[VPROUEMENl'LOCA;�14N,
Address: L I I.�O HL&u i-I >
Legal Description:
Property Tax ID .114 0—Sup— np9 p— o'M— `7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Sider
DERAILED DESCRIPTION OF WORKa ry ��,� �� ,.� 1� .� �E,
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-t ..,_:. .. �,,,. _`i.-+f�... _ .. .: . .:::.. .. ,� .:-tt�.+: t .,.:. .,t e,-�.,,'..1� t. r•c,. ;E ..€x{, EA Ps+Lr' -�, ',s`'_ai .
Add itiona I work to be per o rmed un ert ispermit—c ec 'a I I that appy:
_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:$ 3, 100• 00 Utilities: _Sewer _Septic Building Height:
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NameLCQVICI one-�FP. SII I0+�—. Name:
Address: L4 I Sd ( I u L IC Company:C r cTh u-)S C- '
City: lPrC(e State:FL Address: U903 CrybGr0- LGnE
Zip Code:3LI9 y9 Fax: City: U! ,t 'P I 6!�t CE State:=L_
Phone No. Zip Code:3yg—_ Fax:�]7a-X'OI
E-Mail: Phone No 7-]0- (a34--C 9 9 1
Fill in fee simple Title Holder on next page (if different E-Mail i Cil
from the Owner listed above) State or County License CHC I QC��
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
- $ girl gs.,s.�.5 r
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5lJMI�iA` TRUt� QN LI�'N'LA1 INFORMAT10N1 az +<� sF ; x} ,
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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,periform 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- 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 aOwner/Lessee/ n ctor as Agent for Owner Signature of ontractor/Lice s Ho er
STATE OF: IiSTATE OF FLORIDA I
COUNTY FLORIDAOF J} , L_y(' ice_ COUNTY OFA.
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The for oing instrun ent was acknowledged before me The. for ing instrument was acknowledged.before me
fhi> ay of f-' 1 2011 by thi ay of r; 20 by
.(Name of erson acknowle ing) '(Name of'pelson acknowled" )
(Signature o#Notary Public-State of Florida) (Signature of N tart'PubGc State of Florida)
Personally Known OR Produced Identification _ Personally.Known OR Produced Identification
Typeof Identification Type of Identificatio
Produced IF(-_ L Produced P�__Stephanie ���--
(� 3 . ` YAo.NOTARY P oU IG Stephanie Moor
Commission No. I I �-� " -6)
(*1
1 fission No. f e NOTARY PUBLIC
STATE OF L
W,'" "comm#FF. 381 0 c STATE OF fL0 1 A
G xpires 247ZO203
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLF}9 M%gbVfI2 2
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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