HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: p�'�� A0 Permit Number:
AFS ��c�fGF
Building Permit Applicatiol �R'0, ���1®
Planning and Development Services
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Building and Code Regulation Division F
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROP®S:ED fN'PR®UEMENT L®C�A�TIO�N: a . y
?m!9�,wmm �.,..., re.�&a-?�..rSas.�-x�r�'' #.wm�.a ....m,� •+5�' a, � _d Address:AZ_'_ 5 SJ
Legal Description:
Property Tax ID#: � rJ4z)X-A:�� K-mO-d Lot No. '
Site Plan Name: Block NoA _
Project Name:
Setbacks Front Back: Right Side: Left Side:
4
I
DET�AIaLE�D�DESCRIPTI`0'N QF�INORK
I
11v, W) EU4Y C_-
CC?'N 41TRUCTfON INaF®Rf1/laA ION.
AddIti�qal work�Mechanical o e pe o med Gas Tank under this permit–Gas Piping c a that apply:Shutters Windows
/Doors
g — ttWiDoors— /
—Electric —Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
00
Cost of Construction: Utilities: —Sewer —Septic Building Height:
m
OUV,NE�R/LESSEElowC®:NRAOR':
Name 5clw� Name: ' S/ -
Address: q S Lof4m Company: ' e.
City:S . ;State:L`Z— Address: 03 SL✓ U
Zip Code:. �°1Sf Fax: City: -VE State:`L
Phone No. 4.�6L{ Zip Code:ML2 Fax: Nld
E-Mail:N( �– Phone No 7a a -New
Fill in fee simple Title Holder on next page( if different E-Mail t u�
from the Owner listed above) State or&nty License- _(:2uel 'aQ
I
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Y Sl1�PPLEI\/I'EN1"P►L.C®NST'R�U�'TI'®N° LIEN E,41N INF®!Itl\/IP�T'I�Q
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/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF sk CX COUNTY OF S3-= LkX
The forgoing instrument was acknowledged before me Theforgoing instru ent was acknowledged fore me
� a
this �ay of az 20 lay this ��ay of 209LAUy
(Name of per-56n acknowledging) (Name of person ackno�ng)
n JA �
(Signature of Notary Publict-S-tate of Florida ) / (Signature of Notary Public-Sta a of Florida )
Personally Known OR Produced Identification v Personally Known OR Produced Identification
Type of lclentificptip Type of Identification \
Produced Produced
ELLEN VA U G H N
State tgr66� v Commissio N�y"o% ELLEN VAUG.I{$@al)
CommI5510n No. ,itP Vec; tate of F }Notar Public vr`'
+= ommission #GG 270079 _? �. or orida-Notary Public
My Commission Expires Qc%oborP"= Commission # GG 270079
sMv
'°'�"�� O tobtlr 22, 2022
REVIEWS FRONT ZONING SUPERVISOR PLANS T ANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW 'REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014