HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: U ' Permit Number: / 0 � �•
RIL
Building Permit App licatio AUG 2 2 201
Planning and Development Services 8
Building and Code Regulation Division Pe I ni ittl n JDe i•�i x,11 t
2300 Virginia Avenue,Fort Pierce FL 34982 e
Phone:(772)462-1553 Fax: (772)462-1578 Commercial esWrIfFil? cL
PERMIT APPLICATION FOR: Demolition
PROPOSED IMPROVEMENT LOCATION:
Address: S< <reln D IZt'&2. ri, 3YVL
Legal Description: W I- ILI k 157, 6L IL 57 1-nol-t- tv t ye„ _ C1- 4.46---e-r UN47do
!n
Property Tax ID#: 3�O Z. ®� d R 2 �0 Lot No.��
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Y Left Side: _
DETAILED DESCRIPTION OF WORK:
PMOV' n9 e 1 Stix d2Ct Cin el Q001
CONSTRUCTION INFORMATION:
Additional work to be performed under t ispermit-c ec a appy:
HVAC 1 Gas Tank 0Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers F Generator E] Roof Roof pitch
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$�C�_L Jl Utilities:In Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name L'r Name: �+ r
Address: �C rv� 7 Company: n
City: State: Addressr��. 2
Zip Code: 3 Fax: city: 'Fbt,-1/Pie,rC State: FL
Phone No. 2 $�2 9 2vq 1 Zip Code:L3` %) Fax:-1-7ok LKA-1 102
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:T a b Il( Ih in ,
from the Owner listed above) State or County License: S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
i
SUPPLEMENTAL CONSTRUCTION,LIEN LAW INFORMATION:
DESIGNE ENGI EER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: 0 State: FL City: State:
Zip: Phone Z 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
`< < a
Signature of Owner/Lessee/Contractor as Agent for Owner Si o i se Holder
STATE OF FLOQN ATE OF FLORI
COUNTY OF J� COUNTY OF � �
Thef ring instr ent was acknowledged nowledg before me The f i stru n ck wledgefore me
this ay of 20 by this day of 20 by
-
Name of person making statementName of perj5po 3king statement
Personally Known OR Produced Identification V/ Personally Known OR Produced Identification
Type of Identification Type o entification
P duced Prod
tMv RACEY W.MCGHEE
NOTARY PUBLIC
a re of Notary Publi lady PUBLIC (Si at re f otary Pub�L/4%E
jOF FLORIDA
C�rst FF241935
Com ission No. ���fFFLORIDA Commission o. Expi so0/20'19
F241935
to 1 Expires 8/10/2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
.DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17