HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED j _
Date: Permit Number: ! 80 `DBDa,
s
LnMAY
ECEIVED
Building Permit Applicati 11 '018Planning and Development ServicesBuilding and Code Regulation Division County, Permitting
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: V C
Address: V S 1 J -
Legal Description:
Property Tax ID#3 4- 5- i-1903. 3061 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ETAILED DESCRIPTION OF WORK:
-- --- - -- --
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Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:r Sq. Ft. of First Floor:
Cost of Construction: 0 Utilities: —Sewer _Septic Building Height:
Nam"e % a>JC.,ne I-Of e4x 6e, Name: W f-w Mi Its
Address: 1 (0 &IIAleCompany: Aulis lis A ir' Cnr��' ZnG
City: Tegyes+p� State: FL Address: 144= -S s w &ot am^h Ave
Zip Code: 32 Fax: City: P94 S}- LVCJ e State: PL
Phone No. Zip Code: 34a5-3 Fax:
E-Mail: Phone No ??a- x[08' 7110
Fill in fee simple Title Holder on next page( if different E-Mail S1 I I C M (� rAS n, cow\
from the Owner listed above) State or County License CAC (g I y 1 Q
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
UPPLEMENTAL 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
commencing work or recording our Notice of Commencement.
-N �& MILIA -'t 4
Signature cf Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S50•_a� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
t
his�t day of Ma._ 20 t7 by this day of 201'$ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Statb of Florida ) (Sign-atu�re oYNotary Public-State of Florida)
Personally Known OR Produced Identification Personally Known ORProduced Identificati6AM
Type of Identification - pe of Identification: of lore
Produced pry Public-State of Florid oduCed V Y � •Expires,Gec 20,2018
* �}, y Comm.Expires Dec 20,20 8 -; ' ssion#FF 177249
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ssion #FF 177249 Bondedthr onallilotsryAssn.
Commission No. %', F oma• ( iI mmission No.
Bonded trrowfl i._ 'onal Notary As
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
R 7/2014
ev.