HomeMy WebLinkAbout1901-0285 ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ).��U�
Date: Permit Number: 1
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: /Aa
r wc2y/-? ,t
Property Tax ID#: — 0 Lot No. V A �•5 `k-
Site Plan Name: 06��' A061 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
.DETAILEDDESCRIPTION-OF WORK:",
CONSTRUCTION INFORMATION:
Additional work to (e� ne orme under this permit-check a appy:
HVAC L_J Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric El Plumbing Sprinklers 11 Generator of Roof pitch
Total Sq.Ft of Construction: 0 Sq.Ft.of First Floor:
Cost of Construction:$ '� Utilities:O Sewer Eleptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ` ' Name: C C� '2CD
Address: .5 i- � Company: C000-pt
City: -� "' , Pi.`e r-C 2 State: Address: v
ZipCode: City ate• L—
Phone No. Zip Code: '?&_?3 Fax:
E-Mail: Phone No. 7 a —9ya - !cg
Fill in fee simple Title Holder on next page(If different E-Mail:_ ha 0ei2e_ cow--.
from the Owner listed above) State or County License: CYCC J 30_1?te Sal
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: 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
commencling work or recording our Notice of Commencement.
Signature of Owner Lessee/Contractor as Agent roc
Sig to a of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA /
COUNTY OF �_li//G`J� COUNTY OF S'7-- 4—
The fo ng instr ent was acknowledged b fore me The fo ing instr nt was acknowledg efore me
this day of O y this day of 2t by
S h�ar�ertP -��-vf-efe vto A--e
Name of person making statement Name of p son maki g statement
Personally Know R Produced Identification Personally Known Produced Identification
Type of Identifi ion Type of Identifi ion
Produced: Produced
(Sig ature of N to Public (Si nature of N Public-State of Florida)
rip ubrc state of Florida
Commission No. '� IidCastro C mmission No. =4d0 :Gg241
04 L
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MY a
Expires 07022G 2a087a
Exp4
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MA
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17