HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p�
Date: / o " (� ' Permit Number: J Oy � •
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=iY4 Building Permit Applicat on OCT 0 8 2013
Planning and Development Services
Building and Code Regulation Division LPerrmritti4lg v'epar�L��`en2300 Virginia Avenue, Fort Pierce FL 34982 I_UCI� 11 i I�:'qrr �Phone: (772)462-1553 Fax: (772) 462-1578 Commercial Resi -
PERMIT APPLICATION FOR: '
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ISS:�i."a4?
Address: Z�(o 2 °� 2 R l®
Legal Description: C-��4 L-(� G �� ���� �5 �l 44) c (ol
Property Tax ID#: y cXtp �71-) ? CC) 25 00c�) Lot No.�_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work.to be pertormed under tT is permit-check all that appy:
_(Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generators �1
Total Sq. Ft of Construction: 3 2-06 . Sq. Ft. of First Floor: ZCDCD o�
9�
Cost of Construction: $ Utilities: —Sewer —Septic Building Height: 1
1
I� 1
1 � ,+ �,
WIN Ya
Name 9 Q- 14+ Name:
Address: Company: �1/i�� 4✓�/��n��� �Ac�i�O
City: Dr2 S e? State:jt7 Address: Z-&&
Zip Code: Fax: � City: ®5 L Stater
Phone No. Z�1`� �- � ��- Zip Code: 2 Fax: W)-4
E-Mail: 71 A_ Phone No 77 2 91T5 ro-2
Fill in fee simple Title Holder on next page (if different E-Mail R_kGL-' l�1z1�"�/1G��✓ O� M/J-/
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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 con'currency 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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Age t01 %, r Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA =
COUNTY OF COUNTY OF
The forgoing instru was acknowledged of rl i9l;11 The fouping instrugiprit was acknowledg d efor rn-<
of 6ent :13,:—P - -up�
0 f 0�e arn'OE-_--
b rn this Vby
this.��day 20V day
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(Name of person acknowledging (Name of person acknowledging)
Aot_ Al,
(Signature of Nc�yry�Puc-State of Florida) U (Signature of.N ow y.PulJc-State of Nri�dzlt)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED T
Kev. 7/2014