HomeMy WebLinkAboutpermit application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: Permit Number: D
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 TYPE:
Address: bDO f An1!-=aac1 C e� eCLt E�l 395 pr
Property Tax,ID#:N 3 9-"X 0'7- 00 C�0 Lot No.3C�
Site Plan Name: Block No.
Project Name:
Now '14
ei
011
(Additional work to be performed under this permit-check all that apply:
—Mechanical —Gas Tank —Gas Piping _Shutters _Windows/Doors
—Electric _Plumbing —Sprinklers —Generator Roof — itch
iTotal Sq. Ft of Construction: g O O S y Sq. Ft.of First Floor:
'Cost of Construction:$ •6,S 0 0 Utilities: Sewer Septic Building Height:
e, , Vol
ti
Name?jci IF e— NACr\44'r Name:Ro\e,nZ U3 kSi
Address: 3 iD iJ A nZ&az,, Nr• Company: �o :cat -oo (1
City:Fo.{fi P zfC Stater Address: 1 73 SL3 e
Zip Code:? 41 Fax: City: 1z,(25' S!r�, ;nk LL ,C1 P__ State: C�
Phone No. Zip Code:3 9 153 Fax:
E-Mail: Phone No"71JL—J6Q —5,565
Fill in fee simple Title Holder on next page(if different E-Mail d a,cO na
from the Owner listed above) State or County License C.c-C.( 33 1<
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
If value of HVAC is$7,500 or more,a RECORDED Notice of Commencement is required.
jDESIGNER/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.
certify that no work or installation has commenced prior to the issuance of a permit.
M. 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
iln 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
NDER OR AN ATTORNEY BEFORE RECO DINGYGUR NO ICE OF COMMENCEMENT."
Signature of Owner/Lessee/Co r as Agent for Owner Signature of Contractor/License H 01kri
STATE OF FLOR STATE OF FLORID
COUNTY OFToc, �l' 1 , COUNTY OF Lar�lY)
! The forgoing instr ment w s acknowledged before me The for oing ins ment was acknowled a before me
thi�ay of f 20A by thi My of 01
20�� by
Name of person making state nt. Name of person making statement.
Personally Known OR Produced Identification Personally Known -/" OR Produced Identification
Type of Identification Type of Identification
Produced Produced
CIS
(Signature o otary Public-State of Fll��� c BRANDY MOO RRSignature of Ojtary Public-State of FI {` 9s�� BRANDY MOO RE
�n `�� J� * ; Commission#GG 02839 / # M Commission#GG 0 39
Commission No. y u Expires May 9. 0Ebmmission No.I�GIb2a�J� u ` ) Expires May 9. D
'OFFtoQ BondedfhruBudgetNota 9aAaa � OQ BondedThruBudgetNod B loos
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2/7/19