HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '10 h o C t y Permit Number:
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 _X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 1 I (o Ccs%' �� 1� v -
Legal Description: x ct I e -is frx- Aj7 G'c ,7,t 1A. (2-1 u
Property Tax ID #: 3 `f a 4 _ 3G Lot No. i q
Site Plan Name: Block No. 21
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I i ij l ii) ,I �-�- f vv� 20 a,+tLP 1UJ8V5F2Y
Co
NSTRUCTIflN INFDRMATIC?N4
Addil
zona wor toe e orme under this permit - check a appy:
HVAC 1J Gas Tank ❑Gas Piping M
Shutters Windows/Doors
Electric ElPlumbing OSprinklers Generator F]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ —2 WO - V Q
Sq. Ft. of First Floor: _
Utilities: 0 Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Aa na--t- 'k -,a 01 1 iY1C Yl
Name: N6kk'+i 1
Address: 30`1(0 !2
City: 51 1ye'v-11� , State: IV
Zip Cade::4D CJ0 max:
Company J (9)ncf
Address: 15;;7 ST)yf6 0f='J �f�..-(2' r
City: # State:fi C--
Phone No.
Zip Code:Fax:
E -Mail: _)0Y-%�04 a i1,-t1fM&A 0 A00(L-CC) al
Phone No.]] -a 23-7�-
E -Mail: _/K." ►
State or County License: CAC— If 1776 4
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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 pians, 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 wcy-k or recording your Notice of Commencement., Z/
Signature of Owner/ Agent/ L see/Contractor
SigrTature of dontractoritcenVIolder
STATE OF FLORIDA
STATE OF FLORIDA
S.(_
COUNTY OF � � ��. !`" .
DESIGNER/ENGINEER:
, Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
this i` day of , r 2fl by
Name:
Address:
(Name of person acknowledging)
Address:
City:
State:
City: State:
Zip: Phone
(Signature of Notary Public- State of Florida)
Zip: Phone:
FEE SIMPLE TiTLE HOLDER:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Type of Identificati �" �Y' ` s ; MICHAiaL t3lERHAR'
Mame:
Address:
Produced ..o 6 GERHART
Address:
City:
Commission
City:
Zip: Phone:
FRONT
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 pians, 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 wcy-k or recording your Notice of Commencement., Z/
Rev. 7/201.4
Signature of Owner/ Agent/ L see/Contractor
SigrTature of dontractoritcenVIolder
STATE OF FLORIDA
STATE OF FLORIDA
S.(_
COUNTY OF � � ��. !`" .
COUNTY OF
The forgoing instru ent was acknowledge before me
Theforgoing instr m nt was acknowledgedbefore me
this /6 day of r, z0 by
this i` day of , r 2fl by
nLcl
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known°ee iderrtif
Personally Knowi,� OR Produced Identification
Type of Identificati �" �Y' ` s ; MICHAiaL t3lERHAR'
Type of Identific tiato;' '-.,
'`fir MICHAEL
Produced ': MY COMMISSION u FF230846
Produced ..o 6 GERHART
EXPIRES May 14. 2018
No. "! '' 'a '} rwnaaN cecw+
I : ��..a�, 11SSfON � FF230848
EXPIRES Ma
Commission No.
Commission
lui rctnNWa ySrvn.e eoer
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/201.4