HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O
Date: 7 Permit Number:
= ' "-M
RECEIVED
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Building Permit Application OCT 1 2G�3
Planning and Development Services
Building.and Code Regulation Division -ST,1-991? Permitting
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: VA,C
PRO1t9570D INPROVEME T LOCATI(3N:
Address: Sdz S /4 W
Legal Description:
Property Tax ID#: ' ® J..J' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CISCRIPTIDN • F V1/ORK:
2, TC,71^ I Lc- -A-- L S x s+ tis 4-a 17
CON ST R�U CT I0 I N'FO R�IUI ATI ON
Additional wor to be pertormed under t is permit-check all that 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:$ Utilities: Sewer _Septic Building Height:
OWNER/LEMS EE: CaNTRAC1"fl'R.
Name- Name:
Address: cd. d�S S` i4.ZQS`:L Company:
City: Stater Address! � f:( r K
Zip Code: Zcx-zS-) Fax: City:- State: "
Phone No. Z 3 jLin jJh Z" Zip Cod Fax:
E-Mail: Phone No 77 b d
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.
Ell' PLEME A C®NSUCTIC+?N I.IN LAW ," FO,RMATI N:
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 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
comme cing work or recording our Notice of Commenceme
Signature of Owner. Lessee/Contractor as Agent for Owner Signature of Contractor/License older
1
STATE OF FLORIDA' STATE OF FLORIDA
.COUNTY OF COUNTY OF
The fo ing instru nt as acknowledge efore me The for oing instru :as acknowledge before me
this day of 20 by this�day of 20AL by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif' ion Type of Identificr_u
'
Produced 1. � Produced L L
\�
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(Signature of Not (Signature of Nota .,t#j6 e,ti5tatt( if ic`ia rII ELSEN
`; i�uB KAREN S. NIELSEN a° '_ tate of Florida-Notary Public
��
Commission No. 3� n-:State of FloFF�,td--a-Notary Public =+ Commissio _GG 207464.
mmissib' �G 207484 Commission No. 9 �: y COMM, xpires
iv1 Commission Expires
-���nl MOV June _ 2022
y Juna 12,2022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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DATE
COMPLETED
Rev.8/2/17