HomeMy WebLinkAboutFaria- diagram & permit applicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number:
Building Permit Application
Commercial Residential
PERMIT APPLICATION FOR: FCv\0,p � -TvLL. G
{ PROPOSED INPROVEMENT LOCATION- I
Address: 3daatc�+u o 13c�t Ck
Legal Description: Ecig�e5 {�,�,t+�ca��C' R�
Property Tax lD#: 3y2q-"7oI-00-7L{ b130-�. Lot No. I
Site Plan Name: Block No. :5rl
Project Name:
Setbacks Front Back:
Right Side
Left Side:
I DETAILED DESCRIPTION OF WORK: I
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CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit -check all that appy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
01111NE ESSEE:
Nam, ScA.,-)CA 1Address: 30,0 0, ��% u0
City:r c- /AtU"QI State: i--�
Zip Code: '5140.Fax: /\
Phone No. '1'1 LA "' Raq "
E -Mail: n I ft
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name: o- be✓ri
Company: 'Fe✓jccX Tr\ L -L --
Address: 2'1143 4
City: `Qirrsca k C l C State:
Zip Code: 340'53 Fax: ''IP_
Phone No Lel f` f
E-Mailevl0_ c� g-� . C0 rvi
State or County License A 0 0o --V1 %.51
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LA's INFORMATION:
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 your Notice of Commencement.
Rev. 7/2014
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA `C�
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
this � day 20 AQ by
The forgoing instrument was acknowledged before me
this day of by
of Du5r
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(Name of person acknowledging)
LName of person acknowledging)
(Signat r 'ofLotar ublic- State of lorida)
ignat re of y Public- Stat of FI rida }
Personally Known OR Produce ification
Personally Known OR Pro uced Identification
Type of Identification
Type of Identification_
Produced
Produced
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REVIEWS
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
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