HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COM_ _fED FOR APPLICATION TO BE ACCEPTE1 _
Date: Permit Number: j_706( 0
.Building Permit Application , ��� F�
anning and Development Servicesp10 00`'i
Bluilding and Code Regulation Division
5t•`'vo�e
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR®:POSED IINS P'.Rt E:NT L�CATIO'N:
Address: �Wo -6e G 1� - ��CL \`6�`c� 6_ _C�
Legal Description: ,iC- �(,)%L-�c- 0 V5\\C- -20 0. -�-.
3q Ia-9.5 � tnr? -
PropertyTaxlD#: -� ,� d_d�aa -OcSO-� Lot No.
Site Plan Name: l Block No.
Project Name:
Setbacks Front 30' Back: r' Right Side:, Left Side: 3 y,
DfT ILED ! E�SC dPTION 4 WORK:
' t
CONS RFU TION IN -ORaMAT[IMN'
Additional work to be peffo-Trm-Wea un er t is permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: ,./ Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
0 'ER/LEtS�S CONT AC 0
4.. " l,L e,IL
Name 1`e�� r0 . ' d Name:
Address:-` _ Company; Q_ :54 �O P
City: c e GJ 1 orCi State:_ Address: v5c) P"CL5 o� CRS
Zip Code: Fax: City: oc-�- R c Ci State f=L
Phone No. /Jc a- Zip Code: 1349 ~Ua Fax:
E-Mail: J /`S Cci-1• Phone No 22 a -(.o3 )- q9,1? ')-
Fill
Q.1? aFill in fee simple Title Holder on next page(if different E-Mail l PSL VRq t q-. Q&,A1
from the Owner listed above) State or County License C-G G K I _) �Q
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C®NSl'RU N LI w"IV L W INF® I�/IAT1®N:
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 Commencem nt.
Signature of Owner/Lessee/Contractor as Agent for Owner Signatuof Contractor/License Holder
STATE OF FLORIDA STATE F FLORIDA ( .
COUNTY OF COUNTY OF oG
�I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of ,20_ by this dVday of i5e_bryc c./ 20_L2 by
I� br,q her I"
(Name of person acknowledging) (Na erson acknowledgin
C�
(Signature of Notary Public-State of Florida) (Signature of Notary Publi -State of Florida)
Personally Known OR Produced Identification Personally Known do "MUTHORSON
Type of Identification Type of Identification '
Produced MY COMMISSION#0001477!3
Produced C,0EXPIRES July 24,2020
Commission No. (Seal) Commission No. G6
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED T_
DATE
COMPLETED �G
ev. 7/2014