HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: D '1_r,�- Permit Number:
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Building Permit Application
Planning and Development Services OCT z�)g
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 ��� { C- C t i��
Fax: 772 462-1578 Commercial Resi eatal11
L e unty, FL
Phone: (772)462-155.3 ( )
PERMIT APPLICATION FOR:
Address: '(" j�� L(� "ie
Legal Description: LA ,�lf�a6D � �� ' 6L9C 1. 1 1 �
it
PropertyTax ID#: 1�� - d�y�Z�by�w" �- Lot No. r�
Site Plan Name: Block No.7
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pelormMed un er t is permit-check all tat 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:$ l] Utilities: _Sewer —,Septic. Building Height:
Name Name:
Address: r�rbhmc 16LACC-) Company:
City: Ft o2CJ5 State: Address:
Zip Code: 'AVG.G Fax: City: State:
Phone No. - 46- J49 Zip Code: Fax:
. E-Mail: 51100ktc.5d 0 eel(56u 1hef- Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU'PPL�MENTA CONSTRl1CT1QN L N GA INF� �jMATt4Nk.
DESIGNER/ENG EER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: _ tin-�l� t( �S�SL 'c� Name: _.
Address: LQYCe- 45' 10V Address:
City: X State: City: State:
Zip: Pho a Zip: Phone:
FEE SIMPLE TITLE LDER: _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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commewng work or recording our Notice of Commencement.
Signt,ure of Owner/Lessee/ContLtorAgent for Owner Signature of Contractor/License Holder
STA``T..E OF'FLORI [STATE OF FLORIDA
COUNTY OF la COUNTY OF
The f oing instrument was acknowledgTheforgoing instrument was acknowledged before me
this day of 20/ y _ y
this da of 20 bCst-i�A4-f 17
Name of person acknowledging) (Name of person acknowledging)
(Sig ature of Not ��OR
e of Florid (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification
Personally Known roduced Identification Y
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014