HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a.��l )� Permit Number:
•
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 V
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 IMP.ROVEMENT,LOCATION: K
;Address: CJ�(��" S, —�1'IC�ICI�II ,��r r.
-Legal Description:
Troperty Tax ID#: 340 1 GO t 60(5 Lot No.
(Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
`DETAILED DESCRIPTION=OF WORK
D �,
eplac�. �Yle.�ex 60&S
CON—J16"CT14NIINFORMATION '
Additional work to e e orme under this permit—check a appy:
11HVAC Ei Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
1 _ ectric 0 Plumbing Sprinklers Generator Roof Roof pitch
I Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ?)��,60 Utilities,nSewer Septic Building Height:
OWNER/LES,S°E.E TOR:
CONTRAC
Name 0.11 3 Name: ma" Ekeic iTICI
Address: 5161- c--4 AYl 0_R%w Y r, Company: G
1
City: .�i � Stater Address: 1010
Zip Code: 3L1q$a Fax: City: State:
Phone No. t11aL-AN S-GALIN Zip Code: 34M2 Fax: 'VaI- 41A$S
E-Mail: Phone No. 1101.-Wo I-23p8'
Fill in fee simple Title Holder on next page(if different E-Mail: WI,061'1')
from the Owner listed above) State or County License: BUD 1(63
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION LIEN�LAW 6NF;ORMATION
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
commencing work or recording our Notice of Commencement.
Sign atu re of Owner/Lessee ontractor as Agent for Owner Signat of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA `
COUNTY OFCOUNTY OF '.riA�s�
The forgoing instru�nt was acknowledged before me The forgoing instru ent was acknowledged before me
this day of �. JD C _ 2011 by this I1 day of 20 by
f 1t1J�
Name of person making statement Nairne of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of rida)
Commission No. Seal) Flar ;1Commission No. (Seal)
O1N, LASZ1 A INGRAM LASNAit!�!A t q
P`¢4y of
Notary Public-State of °� Not Y Public.Stat,
} im aA,iRN
p' ( mm.Expir s Dec 2Y o m.Ex ares Dec 20, .OtB
REVIEWS FRONT ";, G Com i8UPERVISO � FLANS VEGETATI(�f�i;�° °SE n ;;IVIPyfV�,� E
COUNTER sir IEV ndedt rougkgVIIE;. rotary ,ssRfVIEW REV'EW 9 ati!na►RkaYyl�
DATE _
RECEIVED
DATE
COMPLETED
Rev.8/2/17