HomeMy WebLinkAboutBuilding Permit Application •A;'AP?LICABLE'INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED .
Date: - Permit Number D57, .0c3-j
CD LINI1 Y
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F R. 0, R I R? R •
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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 Residential y
PERMIT APPLICATION FOR: . _ .
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Address: - o i 'C: t. V'- .,
Legal Description: -r +- '--4-1-1.----.0.42--i---4101^
Property Tax ID#: 13 0 l 613 -6 )3`i -000.-. '3 Lot No.
Site Plan Name: Block No.
Project Name: _ . •
Setbacks `'Front Back: Right Side: . Left Side: '
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•,ditiona wor to •e pe ormed un•er t is permit-chc a I t at appy:
•_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors ,. .,
Electric: Plumbing _Sprinklers - Generator Roof
—
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1)9 S0• 00 Utilities: _Sewer _Septic Building Height:
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Name . Name: �' .L.... ✓I ' . .;
Address: 3 h g c PAcirsk P.c i Company: h.A.loIto Z. ItVIt.,
City: 042 cowCi State: Address: 3 k Bilk"I444 Av-t-,
Zip Code: 3,7)..y' Fax: City: '�C:.: ,
'I State:
:
Phone No. '311 6 c 7- I a S Zip Code:' 3' 'j f7 •• Fax:' `t1 C( -OS/0 •
E-Mail: Phone No. `71OIc '' 0Dl�
Fill in fee simple Title Holder on next page(if different "E-Mail: (A, 'f'f h,vl 7 l crl Le 41o/, &i✓1
from the Owner listed above) State or County License: et ti laljf'�'
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. '
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DESIGNER/ENGINEER: ' Not Applicable MORTGAGE COMPANY: Not. . _ _ Applicable
' -.Name: Name:
Address: Address:
City: State: City: - . - State: ,
...____
Zip: Phone: . . : r . . Zip: . Phone:
. , .
. - . . r .
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 workorinstallation 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,tperforM 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 structure. swimming pools,fences;walls,signs,screen rooms and accessoryUses 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. .
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Signature of Owner!Agent/kesseeSignature of Contractor/License Holder --
. . _ . ,
STATE OF FLORIDA , V STATE OF FLORIDA , , V
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COUNTY OF -- -, UL-4 t. - -COUNTY OF 1—. LA)ci-e_. -
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The fo g-r Oing instrum—ent was acknow -ledged befo .46% m
The forgoing instr- - -------- -- --- - - -- - -nt was acknowledged before (4;eir t ,
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this day of Niel ,20_15‘ by 31. .ez this 2114 day of 1 14%1 ,• ', • ,?0'41'by . 7 7"112:0
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(Name of person acknowledging) @,?,-*5- (Name of person acknowledging), , @g *Er
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to a) 67
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(Signature of Notary •-nic-State of Florida) § , .1T. (Signature of Notary P tic:State of Florida) . ,fZ-1
_ . _ . _
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Personally Known yv OR Produced Identif.. -ton _ Personally Known -^ OR Produced Identificati, -
Type of Identification Produced Type of Identification Produced-
Commission No. i i6.5 (9K ' (Seal) - ' Commission No. )c5.5."66.1' (Seal)
... . _
REVIEWS :FRONT ZONING SUPERVISOR PLANS VEGETATION. SEA TURTLE MANGROVE -
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REViEW.
DATE ' - -
RECEIVED ' "
_ . .
DATE _
COMPLETED - ,
Rev.7/2014 -- - - ..., - -