HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
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Building Permit Application
Plqnning ond Development Services
Building and Code Regulation Division
2300 Vzrglhia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ( OML 00-ca-M 120-, P�dtkfLaz
Legal Description: 6
Property Tax ID Lot No.
Site Plan Name: Block No.
ProjectName:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
A
Val
0"145 3011
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit—check all t=apply:
E]HVAC Gas Tank [:]Gas Piping UShutters Windows/Doors
X-3
r-41
L70 Electric Plumbing [:]Sprinklers IIIGeneratorRoof Rcof pfth
Total Sq.Ft of Construction: SO.Ft.of First Floor:
Cost of Construction:$_2 Utilities:USewer FiSeptisc Building Height:
OWNER/LESSEE:. p' Wofit CONTRACTOR:
q , taM& Daop I I
Name=/ ti YO A: Pn 'MinQtName: DY11iff 1�_ �+a V\(11V1 6VZ_
0-T
Address:00- Company: lrS
City: 021 State:JZ Address:150(i�8 Mq_ - Wbi Qo(-.
Zip Code: Fax: City:- AA-) 6-I rVi'I State•.
Phone No. Zip Code:,1;3 2 91 — Fax: 321-25_0 _2161 fq
E-Mail: Phone No.
Fill in fee simple ride Holder on next page if different E-Mail:dw 4,z a,ip
from the Owner listed above) State or County License: M 63 4R
If value of construction is$2=or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW'INFORMATION:
Applicable DESIGNER ENGINEER: Not A O
I — pp 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 mattes 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 ail 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
commen0fig ilvork or recprding your Notice of Commencement.
Si atu Owner/Lessee Contractor as Agent for Owner Sig t of 6ntractorWense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6f�_26(�, COUNTY OF C�6f„/c(q
The fQ Qirtg in acknQ4vledge fore me The to oing instru t �e�cc@ edged afore me
thi day of 20 y this day of LU 20J
dc,�, da,/ma44dc,7
Name of person making statement c Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id 2�ca'o Type of I cat"s L
Produced �5 f J �i Produced U O`I�i�s�
A� i
(Signature of Nogry Public State of Florida) (Signature of Nota ublic-State of Floridadt
)
Commission No. GE016904UZABETH CANALES Commission No. F.-
61
GE Ik4ELITABETH CANALES
NotaryPu6lic-5tateofFlorida � Notary Public-StateafFloridaCommission GG 124400 Commission 9 GG 124400
: T� "l`'1 e My Comm.Expires Nov 11,2021
rn.a51.,.• ;°,!;`,',•' Bondedt oughNa6onalNolaryAssn.
Bondedthrou NaBonalNolaryAssn.
REVIEWS FRO PLANS VEGETATION i
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17