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 o,9 .
Planning and Development Services St.
Building and Code Regulation Division 44Cie
co ty eq,
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial x Residential
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(PERMIT APPLICATION FOR: Demolition El
PROP.OSMAM;PROVEMENT-LOCATION,. _
Address: SO b (/ 14 1
Legal Description: Dixieland sd-an unrecorded plat sec 27-35-40 blk 4
Property Tax ID#: 2427-801-0037-000-4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED,DESCRIP,TION OF-WORK
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Remove drywall, flooring, drop down ceiling and cooler
CONSTR.UCTiON INFORMATION
Additional work toe e orme under tispermit—c ecK a appy:
HVAC 11 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 1500.00 utilities. 0Septic Building Height:
OWNER%LESSEE CONTRACTOR
Name \/Va dl 0'r ,n c Name:
Address: S CIS Company: Liberty Home Builders, Inc
City: , — P;�. _ State:VL Address:
{ Zip Code: _2oL' Fax: City: State:FL
Phone No. h Z-- Z,C�-z O i2 Zip Code: 34990 Fax: 772-324-8578
E-Mail: Phone No. 772-626-3179
Fill in fee simple Title Holder on next page(if different E-Mail:jell@libertybuildergroup.com
from the Owner listed above) State or County License: CGC 1504157
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
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'SUPPLEMENTALCONSTRUCTION LIEWLAW.INFORMATION
DESIGNER/ENGINEER: x Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: FL 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.
certify that no work or installation has commenced prior to the issuance of a permit.
X. 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 yYr
r ro Notice of Commencement must be recorded a d po the jobsite
before the first insi .'If u i end to obtain financing, consult with lende oryanttorne
co
work r r in o r Notice of Commencement.
Signature of wner/Lessee/Contractor as Agent for Owner Signature o o tractor/License Holder
STATE OF FLORIDAq � STATE OF FLORIDA
COUNTY OF F'�aAAr-\ COUNTY OF M60iY--
The
- -The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9 day of 44ja ✓L 2011 by this day of 20 Ig by
wa[slti-
Name of p4rson making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification ✓
Type of Identification Type of Identification
Produced fi— N Vf rS UC2✓1S-e• Produced OL. Oh\"A-S Q�N►
�C lig,
(Signature of Notary Public-State ,FNwjda) Edith (Signature of Notary Public-Staf` orida) EdithVffa
�a ;r State of F7odda
Commission No.F E97&2.3S-ka:« State OfFlOdda Commission No. '� 1&2-3.. lion
commission Expires 03/6/202G Commiss)on No IFF976 0
Commission No.FF 9762
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17