HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE CCEPTED
Date: Permit Number: p I u-o `�-1
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_ Building Per it 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:
PRFSEQ N`'R41/EM4ENT LOCATIQ'N:
Address: A 0 (J S —f aT- -i-t 7- LU 6 'E
Legal Description:
Property Tax 1,D.#: - �70 - Oo - go Lot No.
Site Plan Name: Block No.
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Project Name;
Setbacks Front Back: Right Side: Left Side:
DfTA�I�LED � E�SCRI!PTfC1N OF WORK:
vtL,D r1 v �� Okcf hCri–wCl - ,�J
as -M IJ. P L4-r tv rr No � � S�(L-
)(MOM
L-)(M 'N-AW10 :
! ional worK to be per Orme un er t is permit-c ec a tat appy:
Mechanical _.Gas Tank Gas Piping Shutters _Windows/Doors'
Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.Jf First Floor:
Cost of Construction:$ Q'S.g Q Utilities: ' —!ewer _Septic Building Height:
0 NER LE-.SS :E: CON R � OR:
Name Ll l;& S'lbfnA-�jfi Name P(ASco -11)-C'2-7- �
Address: (0 �� 1 Ail-) &-r• Company: eA C'p pa(L
City: BLOP1-Lo State:� Addre s: �` Ly
Zip Code: I'�/I Fax: City: AuTOP State:t2
Phone No. _ X33' Sq LF Zip Co e: ._3�f Fax:
E-Mail: Phon 1 5VI-
Fill in fee simple Title Holder on next page(if different E-Mail wez A N�isoye&r7iyeu • 60&)
from the Owner listed above) State r County License�'�P� A g L
If value of construction is 2500 or more,a RECORDED Notice of Commen ement is required.
I
SIJ PLEMENTAt CONST TURRI® tIV LAW tNCFOR.M/�TI®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 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 ins I . If you intend to obtain financing, consult with lender or an attorney before
commencing wA or recdrding your Notice of Commencement.
Signature of Own . ssee/Contractor as Agent for Owner Signature Cont ac ense Holder
Owner
STATE OF FLO IDA STATE OF FI O . DA
COUNTY OF COUNTY OF -,1• ,a
The forgoing instr ent was acknowledged before me The forgoing instr ent was acknowledged before me
this day of 20J_Jby this_CJ day of LM 201�_ by
ASad __Ann C 140-vo��
(Name of person acknowledging) (Name of person acknowledging)
(S ur of Notary PdbliRN,,A gQ f Florida=)=`:� (Signature o Notary Public-State of orida )
10 o� !_ASfiA Hftr
,' a Notar o A INGRAM
y" r`'i'' Personal) KnowrN. M.,
OR Produced lde i� fi M
Personally Known _��" du ed ldenttficavono Fr :a� Y �r,�„f.hwF{� ��AM
Type of Identification 4 '%F ! m,n'. Expires Dec 20,ppia Type T e of Identific ; Notary Public-state of Flo-�� O,OF F40 � s # \""" Bondedr ion FF 171299 Produced c M CommF es Dec 2n
Produced r - _.� hrou?h p,ation t
f�otaryA,sn ,J •���FOFF4°�o`` Commission #FF 17
Commission No. ` Commission No ”""" Bonded g:h
Na:(Sg,a
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014