HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,r1�
Date, i���-?-�/_� Permit Number: ��J' ' `f'V/d_J
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- JUN 15 201$
Building'Permit Applicati n
Planning and.DevelopmentServices Permitting n'epartmen
Building and Code Regulation Division St. LUC' County, FL
2300.Virginia Avenue, Fort Pierce FL 34982 '
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PC 1p,
PROPOSED I'NPROUEMENT LOCATION: _ �,
Address: C � 1�, �f ► � ' �(/` 3�
Legal Description ► !� °; i _` 1 )' t <`
r-- ,` t ' t ) -i s 1 d r
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Property Tax ID#: i 64 r 10 r � � � Lot No.
Site Plan Name: Block No.
Project Name: AN) rl. tf r
Setbacks Front Back: l t Right Side: '/V Left Sid : w
DETAILED DEQ CRIPTtON OF WORK:
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06P n
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LC@NSORUCTWW INFORMATION:
Additional work to be pertormed under tis permit-check a .'t;atappy:
_Mechanical _Gas Tank _Gas Piping Shutters Windows/Doors
_Electric _Plumbing _Sprinklers s Generator _Roof Pitch .
A,.l M e^r"
Total W Ft of Construction: a W 93 Scl Ft:•of First F o.or:' %,'-,:. -
Cost of Construction:$ Utilities: —Sewer —Se tic Building'Height:ht:
OW 'ERf LE=�SSEE: CtJ TRAOR:
Name h CA-A `l '�� nj 'T•.t r Name: ;,
• J110'.
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Addre { 1 �" '. f eCi; ^L f„ Company:
City: ti I ti - - - State:� �� Address:
Zip Code: +` - Fax: City: State:
Phone )� �'��` d Zip Code: Fax:
E-Mail: , Os1i `; 1'� (�' f s- ,��IoneNo
Fill in fee simple Title Holder'on next page(if different -Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S,t1P'PLEMNNTXLC*ONS1'RUCTI�N LIEN L 1N IIU'FOR+MATIO'N:
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 thepermit 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.
Signatu ofrn4/Lessee/Contractor as Age ��4Q Signature of Contractor/License Holder
STATE OFRIDA ` �? STATE OF FLORIDA
COUNTY OF COUNTY OF
�m<
The forgoing instr nt was acknowledged of � gv The forgoing instrument was acknowledged before me
this ay of 201 by this day of 20_ b
�us y
1 a crnnnS
(Name o perso, acknowledging) (Name of person acknowledging)
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(Signature of N t ry Public-State of Florida) (Signature of Notary Public-State of Florida)
Person y wn OR Produced Identification Personally Known OR Produced Identification
Type of Identifi tion Type of Identification
Produced 1 Produced
Commissiono. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.