HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 0
Date: Permit Number: r Y
_ Building Permit Application OCT 20117'
Panning and Development Services
Building 9
�l n and Code Regulation Division
23 00 Virginia Avenue, Fort Pierce FL 34982 County,
FL
—
,phone: (772)462-1553 Fax: (772)462-1578 COCTII'1'lercial Residential
�ERMIT APPLICATION FOR:
PROPOSED INPRaUfM1ENT 4C
Address: 69 ZO v /U
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name• a i e i° Block No.
Pri ject Name:
Setbacks Front Back: Right Side: Left Side:
D TAILED DE���RIPTIQN QF WORK., , .
i
lU _(AM D GG C �S4,G(�OO
v
CONSTRUCTION iN�FOR�MATiO'N:
itiona wor to a pe orme un er t is permit-c ec all that apply:
—Mechanical —Gas Tank _Gas Piping —Shutters _Windows/Doors
—Electric —Plumbing Sprinklers. =Generator Roof Pitch
Total Sq. Ft of Construction:
�J Sq. Ft.of.First Floor: .
Cost of Construction: $ G lC S Utilities: Sewer —Septic Building Height:
0 ' NER/LE-�S�SEE: CCJNTRA �`OR:
Name `49 47 Ct. e 'Na 'me: /�/, ,., a -
Add ress 0 to Dr Company: v G ��f✓
Cit . •B State ',h Address �� � ,c�G� . cf
Zip Code: / Fax: c City: State:
Phone No. ��(�-6k)t _ J Zip Coder _ Fax:
�E-Mail: Phone No c;Z `
Fill in.fee simple Title Holder 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.
SUPPLENIENTA CQNSI'RIJ�TI�N l.l!EN I_AW IMFO'RMAI"ION:
DE ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: /
City: State: City: _ / State:
Zip: Phone _ Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY- Not Applicable
Name: Name:
Address: . Address:
City: Cit
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
commen
qngwork qgj@9ttftrtgour Notice of Commencemeta .
1
Si attire of Owner/Lessee/ on ra for as Agent for Owner gnature of Contractor/licks- Ider
STATE OF FLORIDA STATE OF FLORIDA— '
COUNTY OF COUNTY OF .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this' day of C)(Lt 20a by this <- day of , 20 0 by
Name of person making staternert. Name of person mak g statemen
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
•. ..
LASHAHN
AIN4 1A1*VAI
(Signature of Notary Pu G^ Im i °'Mate of Florida (Signature of Nota # .Lifcligsl a�j Slate Of
b ds g �
.o�� m.Expires Dec Z0 2018 '°; °���` commis rXllires pec 2plorlda
•�of Fiop.�`. CofifiisSion#FF 177249 Bondedl sip ` 17 201®
"""'" Bond hrou hl ei3 f 72'4
Commission No. . ���byghNationalNofar Commission No. -- y g Y nova!Y Assn. �_� Notary Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.