HomeMy WebLinkAboutBuilding Permit Application All APPLI�ABLL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Number:
Date: y V
r r
Building Permit Applicatior�,, o 5 205$
Planning and Development Services
Building and Code Regulation Division
Permitting Departinent
2300 Virginia Avenue,Fort Pierce FL 34982I + `L
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Reside�'ti�a�e C u - '
PERMIT APPLICATION FOR: nL S L
PROPOSED IN PROVE MENT.LOCATION: -
Address: ��S / 74G4 vim'
Legal Description: BIZ l'A IC.- U "1-Z' 1K- L-1—C,C q-gam Zz/� - o� -
3.V4-ag7/ ; 3 y- 219
Property Tax ID#: - 00/Y Obo - Z Lot No. l
Site Plan Name: Block No. /
Project Name: _
Setbacks Front "t Back:4 Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: :.
qua . 6 L 0?;�X-1 el A,16 �f���c :Zvi d
CONSTRUCTION INFORMATION.
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric__-_____Plumbing _._Sprinklers-_ —Generator `RoofPitch_
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
r
Cost of Constr.uction:.$ Utilities: —Sewer _--Septic Building Height:
OWNERAESSEE . .. CONTRACTOR:
NameV D �/ U -z Name: e'1 -.-+ ��•* if jAc s�
Address: '1 `X��f /'I !�'� Company: -5
City: State: Address: //7 0�ee� A,—
Zip
,—
Zip Code:^3i � Fax: City: 02 i e/-C-Z Stater
. - JZip Code:
YPiore No20 7 Fax:
E-Mail: '� Iq Phone No(V-2) 33.2—
Fill
3z—Fill in fee simple Title Holder on next page(if different E-Mail S� �b�+ r- �•^'�AS`� rle�
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEiVIENTAL CONSTR`UCTIO LIEN LAW INFQRMATIDN
x
DESIGNER/ENGINEER: Not ApplicableMORTGAGE COMPANY .:.o; f Applicable
Name: Name:
Address: Address:
City State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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.
Signature 6f' er Lessee/Cont,ae�9t as Agent,for Owner ure of Contracto ce se Holder
STATE OF FLORIDA STATE OF Nod C�,ro1�via w5
COUNTY OF COUNTY O)*FU wL k—
The forgoing instrument was acknowledged before me The forgoing in trument was acknowledged before me
this day of 20_ by this Zco day of i 20 1 1�3 by
Spv l �Z
(Name of person acknowledging) (Name of person acknowledging)
// ff
(Signature of Notary Public-State of Florida ) (Si ature of Notary Public-State of Fkw4e[a) ;
NoP�'h euvtli►.c..
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced Flo6ga- I)L.
Commission No. (Seal) Commission NoQolutU L000il iUiE H W.STRICK i I ND
Notary Public
Bn lnsmkk Co- Noah
My Commi ion Ex irss Ma 1 , 21
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014
t
SUPPLEMENTAL CON STRUCTIO LIEN LAW)N,'F RMATION':'
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: — of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: t Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 obt ' inancing, consult with lender or an attorney before
commencing work or recording our Noti Commencement.
s
_Signature of Owner/Lessee/Agen Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SJ— L.kt,c&k- COUNTY OF
The for oing inr rnent as a knowledged before me The forgoing instrument was acknowledged before me
this day of ��,,���1,�, 20J�by this day of ,20 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary ublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR ica i ers nally Known OR Produced Identification
Type of Identification Produced e OE o A? of Identification Produced
Inv, ,y,..'...--i
� n
Commission No.� c31-9 (S I Commission#GG 38 93 ission No. Seal
y comm.expires Oct.22 ge9w
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS