HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE CCEPTED, ` '
Date: ermit Number: SICU O'[z.,X
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 _
PERMIT APPLICATION FOR:
Address: �- -�'6t�(/ `tl��Q G./ j r3 s^
Legal Description//:lj�,u occand v �a-14- � -of
��or� � 4J
Property Tax ID#: -,r02 - O 0.32 • D D O f Lot No. A4
Site Plan Name: Block No..
Project Name: 014444r/
Setbacks Front Back: Right Side: . Left Side;
Additi wor to .e pe ormed unde t is permit-check d1l tat a Ply.-
-Mechanical
y:_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:$ �'j.7 ?� Utilities: _Sewer;"_Septic' Building Height:
Name e 1"J. Q a 1r' Name: /✓1R.1_ f_�
Address: J c/ if / Compa y: qoo,1,C ✓ / 41"
..
City: C✓<< . State: iCl Address: ec re 6n,&/
Zip Code: 399.r/ Fax: City: , G/e-c State:fr
Phone No.772 337,- a/2 Zip Cod 9 Fax: 72,4�,
E-Mail: /y'�/�7 Phone o. 722—
Fill in fee simple Title Holder on next page(if different E-Mail: 17PA4. ao • C�h'�
from the Owner listed above) State oi County License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:. XNot Applicable'
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: �lNot 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.
L certifythat no.work or.installation:has tommencedpriorto the issuance of a permit. -
St.Lucie County makes no•representation that is granting a permit will'authorize,theppermit.holderto build.th:e.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$t.Lucie.County Amendments.
The following building permit applications are exempt from undergoing-a full concurrency review:.'roorn 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 poste"d=ohl-he 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.
Signature of Owner/Agent/Lessee15ignaiure of'Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged,before me, The forgoing instrument was acknowledged before me
this day of 20_'by: this day of ,20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida). (Signature of Notary Public=-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifcation Produced. Type of Identification Produced
Commission No. •=(Seal) Commission No. (Seal)
REVIEWS FRONT ZONING `SUPERVISOR PLANS VEGETATION SEA TURTLE - MANGROVE
;COUNTER REVIEW REVIEW REVIEW REVIEW: '4 REVIEW , _ :,',.REVIEW
DATE
RECEIVED
DATE`.:,
tOMPLETED-
-R-e-v-.7/2014