HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .Z 0 Permit Number:
IIIIIIIII�IIII,I„��„1�1� IIII•, II�III, ��-�� �
* i
._
Building Permit Applicatio
ty Planning and Development Services ST. Lucie Cou ,Permitting
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: S �
Address: 0 0 �`f1 i ra r1 q J► /C + t j e/4 t I:/, .
Legal Description: 0 ul d pA. [A Y1_;
Property Tax ID#: od z?-- d o av Lot No. a S _
Site Plan Name: Block No.
Project Name: 5�VCkYY ,-,-_)
Setbacks Front Back: Right Side: Left Side:
d 1 h /-7 e
Additional work to a pe OrmeOR er t is permit—.c ec a tat appy:
_Mechanical Gas Tank _Gas Piping 1'4 Shutters T Windows/Doors
Electric Plumbing _Sprinklers _„_Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ .3_ (G� Utilities: `Sewer _Septic Building Height:
.Name', ac a .: 'X'6,m C'_ Name: - .A . ._..t .
=Address: 1`14t)7 a�;�1C'�AYI'q ' CCompang:C-p4j A/
+C'ity,;;.. T” 1Q+ �rC-C State: ��- 'Address: i
Zip Code: ;�� `'�
�� q� 'Fax: City: �. d"�..e✓Cr` State:
Phone No.441-713-- o�i9`,� � Zip Code: 3J9 ! tri Fax: 772- ` AASI.s
E-Mail: Phone No 97.2^tiro j- Q2/14
Fill in fee simple Title Holder on next page(if different E-Mail, r,001, +.rky b 1 G ia_ va ted. co^_i
from the Owner listed above) State or County License d'CG1311S/s etr
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: X
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 thework 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 AssQcj6tiori rules, bylaws or and covenants that m restrict or prohibit such
1c
a
structure.Please consult with yoUr-Home Owners Association and review your deed for any restrictions w hmayapply.
In consideration of the granting of this requested permit, I do hereby agree that]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 your Notice of Commencement.
gnatureofown-er �Essee/ContractoratAgent for Owner-�. .. fgnature.bf ContracidW0icq-6se Holder;
STATE OF FLORIDA,I STATE OF FLORIDA,
COUNTY OF __)Ir COUNTY OFCa"�
The forgoing instr was acknowledged before me The forgoing instrurpent was acknowledged before me
"gnatu
2CM by thisgIf day of - )'-M!l 20 2D by
thlsMd day of ...................
_Name of person making statement. Name of'p6rs6n making statement.
Personally Known OR Produced Identification 1�^ Personally Known OR Produced Identification �
Type of IdentificationType of Identification
Produced F-WkIDPr NIVU- LIC4A X Prod'uted t _01
zw_,Z1
gnatu
re of Not Kld`ubI6_State of Florida (Signature ub I E
OR of Florida
'n
R D VA7QUEZ ublic-State
a lic Commission N N W,�n
Commission NAA state of Florida O.� 189 1
941 F Feb 26,
Commission#GG 1 0 M.Ex M Notary
Assn
FebMVComm.Expires 26,2022 �tit4atlonal
14
..
r N 'I
. . . ..;"Bonded throug aI101101
WIMP—
REVIEWS FRONT .SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
'RECEIVED
DATE
COMPLETED
Te'v.