HomeMy WebLinkAboutBuilding Permit Application All'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: QO
. .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:
PROPOSED IINPROVEMiENT LOCATI °N:
Address: 9 LF 4V .te t . ie-r-ce j=i... 4-
Legal Description: f uu" =�. ro I✓ A-/ 04f
Ca c rL,+-z
Property Tax ID#: Lot No.
Site Plan Name: Block No. .
Project Name:
Setbacks Front Back: Right Side: Left Side:
I
'31
Df SAILED DE�SGRI�Pl"ION OF WORK.
.t--Jrc V � G !w��,y ra ti f w4-4 r7. K,vJ, cam{
CQ STRUCTION bNFOR,MATlON:
daitional work to be performed 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: Sq. Ft. of First Floor:
Cost of Construction:$ �a Utilities: —Sewer —Septic Building Height:
,W ER/LESSEE: CONTRACTOR;
Name J . Yee-.VmaV1 Name: r1k M Ltl "
Address: 4 C t� AV2 M Company: cif-f z bt,QGtv At J"g C_,
City: t e rce- State: Address:.: : N•w,L-oyo I GT S
Zip Code: 47 Fax: City: P - S , L, State: 1^L.
Phone No. �� - ` "' Zip Code: �L}-� �6 Fax:
E-Mail: Phone No I � 7 d
Fill in fee simple Title Holder on next page (if different E-Mail (,!J and Otgrry Vw Cow
from the Owner listed above) State or County License. f✓� C-( � �7 3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
atJPRLEMENT' L CONSTR�U'CTI�N LIEN LAW 1N -®RMAl"tO-I�:
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 i spection. If you intend to obtain financing, consult with lender or an attorney before
commencin ork or recordingour Notice of Commencement.
i �.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Con actor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ISA COUNTY OF
The forgoing inst ment was acknowledged before me Theigrgoing instru ent was acknowledged before me
this l3 day of 20� by this I,K day'of
20L$ by
14
(Name of person ackno ledging) (Name of persona nowledging)
(Si ature of Notary Public- to of Florida) (Signature o Notary Public-State lorida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification —= Type of Identification
.�
��uuu� ''�"�`Rc duced
Produced ,�taR�p".
LASHAHNAINGRAM
Notary p r "'�'>, LASHAHNA INGRAM
_ J Public-State of Flor d `.]+ o `a�;%
Commission No. N w a Qc� e")nm. Expires Dec 20,2 118,'Commission No. +I _'2��*�; No(Seal))lic-State of Florida I
a ,
E oa,c Commission 'FF 17 4 My Comm. Expires Dec 20,201 1
7295 s` " Commissic. ;,FF 177299
Bonded(h uurliP,Nre n I, li ,,, F: n
"" Bonded thmun;i Mation"I Notary Assi. l
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIO SATURTEET" MANGROVE~"
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v. 7/2014