HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number-
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Building Permit Applica = -
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:
PROP�Sf D I • ROUEMI?NT LOCATI{JN
. n
Address: �,� 'IV 3-7-A S-�ftt,4 � p rCe, 3'1 q
Legal Description: 25un .0 n J 6a' y- erI S ALK I I Lo L I a (n,12
Property Tax ID#: Lot No. ID
Site Plan Name: Block No. l •
Project Name: �WViS
Setbacks Front Back: Right Side: Left Side:
DE ED DE�SI 'TI ONOR
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Lz,bl� /)i,1)I d nic-A� u", r - r ? .
CO STRUCTIO'N �NFQ •+ � TION:
itiona I work to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _.Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator _t, oof Z Pitch
Total Sq. Ft of Construction:: �tf S Sq. Ft. of�First Floor:
Cost of Construction:$ 1/a fX0 0 Utilities: 1, ewer. _Septic Building Height:
OW. E•/LE� ISE: CONT'AC aR:
Name ClYIR01') t%5j
Name
Address: - Company
City: IAC :j;` Stater Address � �`: e-&V
Zip Code: �y�{I_-(7 Fax:2 City: y �i rfG2 Stater
Phone No. Q ^ ✓ 2- Zip Code: RiqFax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 0_6(_ 2--7 7-0
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required:
S PPLEM �N ;�L. •�NST +tJ�fION LI �N LAW I�NFURMATIC� ; WIN.
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. .
Signature of Owner/Lesse /Contractor as Agent for.Owner Signature of Contractor/Lic nse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 3-61-yey a COUNTY OF -?V:Zile ,e-
The for gig instrument was acknowledged before me The forgoi�n,�g instrument was acknowledged before me
this dot day of Jiglyl r�20-LQbyby this day of _`Ju '4 20-H by
Name of person making statement. Name of person making statement.
Personally Known ✓ OR Produced Identification. Personally Known / OR Produced Identification
Type of Identification Type of Identification
Produced Produced
L1\ 1A
(Signature of Notary Public-State of Florida) (Signature o Notary Public- t t f I r'
Commission No. {N"` Notary P{ $►ate of Florida Commission No. ��ryFHarristetedblic S-o}Fbride
Sophia ares is Hams (Seal)
My Commission GG 238873 y ,g Ex ires O5 ion 2O 238873
+�j dr Expires 0513012020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.