HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE NFO M ST BE COMPLETED-FOR APPLICATION TO BE_ACCEPTED
Date: �- �� (- Permit Number: 9q
-J
'building Permit Application
Planning and Development Services
09-
Building and Code Regulation Division
2300 Virginia Avenue,'Fort.Pierce FL 34982-
Phone: (772)462-1553 Fax: (772),462-1578 Commercial Residential :V y
PERMIT APPLICATION FOR:Jill ,
S �,vc-
PR(-3P _QED INP , DEMf NT L®'CATION:
Address: Oa °II F_-°TLES
Legal-Description:
p ,
Property Tax ID.#: 5 ✓lU L� / 7 �bd d Lot No.. r_�a
Site Plan Name: Block No.
-
Project Name:
Setbacks Front Back: Right Side: U- Left'Side:'
V1 '0
CQ TR C I0'N FQ ,M, TON:
Additional work to Be performed.dunder this permit=cFeck all t atapp y:
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:$ 0 Utilities: —Sewer —Septic , Building Height:
kR/ ENS CONTRA OR•
j •� .F E -y'f'l s..I l A Sf0-11't
Name,, :7C. L Name yl E PAR
,
Adddress 'f.p f 1c67T'L RLIf5 Company
City:,/ t;xIS - l'l-� J=L State: Address -
Zip Code: q 5 Fax: City:' '{' State:
Phone No. Z (e3-do49 \Zip Code: Fax:
E-Mail: a.`v1 V' '� Phone No
Fill in'fee simple Title older'on next.page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S �PPLEME TAL CONSTRLI � LI �N LAW INF®RMATI,ON:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: CN(S &�Callcee tom Name:
Address: &)RI �.�, t�CC_L!l 2,Lycf Address:
City: S-t7_2&VZ Stater City: State:
Zip: Phone 14-2-3 -R-4-2 i�1 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
comm w rk or recording our Notice of Commencement.
Signature of O ner/Lessee/Contractor as Agent for Owner Signature f ontractor/License Holder
STATE OF FL RIDA I /� r ` STATE OF ORIDA
COUNTY OF 1V` -t'r►'� COUNTY OF Q'�
The forgoing instrument was acknowledged before me The forgoing instru ent was ackn wledged before me
this 2I "day of Ilia r� ,20_ by this Vst"day of 20_ by
(Name of person acknowledging) (Name of person ackno edgin )
OA� smo,O\
(Signature of Notary Public-Stati6 of Florida) (Signature of N ary-Pu/blic-S ate of Flo •da)
A OR Pr uced Identification Personally K own 1� OR Produced Ide tification
yi l�n toe of Florida Type of Id tification
?z. Type DANAM.sT1P0 Produce
234730 MYCOMMISSIONiRFF81i8716 a � YPEa— D M.SPPo
my Comm.Upir s May 27,201N * '•�'O
``,�. QSS �y 1E`X.PIRES:Merl,7,2020 trtYC�M ION#FF 988715
is�d el'�Houoh atlOfl�IN�iBry rioFFLO$tSEWWThM tNotary,%r,?m CO Sion No. * c� (J, ES: 7,.m20
OWNIMOW29 SWAM
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REVIEWS FRONT ON N SUPERVIS R N VEGETATION SEATURTLE MANGROVE
COUNTER REV/IE REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED tJ � Ct
DATE
COMPLETED
iev.7/2014