HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �� o
Stu
JUN 0 6
__ _. . ... Building Permit Applica ion 2or8
Fanning and Development Services Permitting epal-t men
Building and Code Regulation Division Lucie
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2300 Virginia Avenue, Fort Pierce FL 34982 I o u n ty, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION..FOR: � �, �
PROPOSED INRROVEMENT LOCATION:
Address: fl �S ��
Legal Description: I V 0.ry%S 1.4C S roT(,, G
Property Tax ID#: 0 LO Ol !_ 0190. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: kL) I `..
Additional work to Be pe orme un er t is permit-check all that apply-
Mechanical
pp y-Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _g/Roof 3 J Pitch
Total Sq. Ft of Construction: A6 �7 pone Sq. Ft. of First Floor: 14010
Cost of Construction: $ _� o0) on Utilities: —Sewer —Septic Building Height:_
OWNER/LESSEE: CONTRACTOR:
Name ,�fl y.. . G ry) Name: -Y•
Address: 5k _r0_5 CQ'- _ eLNiSk 1.4) Company: 'C44&
City: I , e-r(-L'e State:�' I Address:
Zip Code:.I qs/ Fax: City: Stater
Phone No. Zip Code: �� f/ Fax:
E-Mail: Phone No -,7 ->> 61-0 >-�-J
Fill in fee simple Title Holder on next page(if different E-Mail .�C' / G,
from the Owner listed above) State or Count License 7 yr
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU.PPLE11lIEtUTAL CONSTRUCT[ON LIEN LAW IN`01 MATION
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
A'
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 ins ection. If you intend to obtain financing, consult wit er or n attorney before
commencing r o-r\recording your Notice of Commencement.
SignatKe-o ; er Lessee/Contractor as Agent forOwner Sig to f C for/License Holder
STATRIDA ST OF ORIDACOLICOUNTY F �11?The forument was acknowledged before me The fore going instrumt was acknowledged before me
this day of 20_ by this S day of v 20�2 by
Nnl oo b
(Name of person acknowledging) (Name of person a k wle ging)
n
(Signature of Notary Public-State of Florida) (Sig ature ot Notary Public to of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificat
FEDE
Produced Produced ✓� pSARY�g� GATARSIN PUB
cI—CAJ
OTARY PUBLIC
ST�jTE OF FLORIDA
Commission No. (Seal) Commission No 8oriim#GG066420
`vc19Expires 1/25/2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE .
COMPLETED
ev.