HomeMy WebLinkAboutLAFUER APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEa
Date: Permit Nu
Building Permit Application
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 APPLICATION FOR:
PROPOSED I:NPROVEMENT LOCATION:
Address: q4-
Legal Description: ci'��c l 5� (
Property Tax ID
Site Plan Name: 4 I's t
Project !Name:
Setbacks Front Back:
FDETTA llL=a D.ESCiR PTION of WORK:
CONSTRUCTION _IN FORMATION:
Commercial
J
Right Side
itjona war to e per armed under this perms
Mechanical , Gas Tank Ga
_ Electric _ Plumbing Sp
Total Sq. Ft of Construction: 190
Cost of Construction: $�
Residential A -
Lot No.
Block No.
Left
_.3
— c ec a t at app y:
Piping Shutter _ Windows/Doors
rinklers Generator _ Roof Pitch
Sq. Ft. of First FlooLtic
Utilities: Sewer _ Building Height:
CONTRACTOR:
Name Vc5 r-- Gvr ` Name: c��V
Addresf�: id� d�� Company: 1�1 C a rt` >`ud lh Uph l�V1<
City: Pep 5 L✓�� State: Address:
Zip Code: `d` Fax: ✓�� City: FCA"fi
Phone No. Zip Code: 3 Y
E-Mail: c E' l [�� Phone No 77
Fill in fee simple Title H !der on next page (if different E-Mail V,
from the Owner listed above) State or CCoouu
nse
Fax �� 1
If value of construction is 2500 or more, a RECORDED Notice of Commencement is
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zi p: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 pe6it holder to build the subject structure
which is in conflict with any applicable Nome 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 Iany restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, iri 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 fuses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement Tay 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
commep-ging work or recording your jVotice of Commencement. —
of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF G
The for_going instrument was acknowledged before me
this -A bay of �i,t Fl-r. , 20;;�J by
RA (-, Cf Q
ame of person acknowledging )
re of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced J Y LC cjn^
Commissio
SA,A3&!A
n'atarY'ubEir State o'; lia r
Signature of Contra dtor/LicenseWo-lder
STATE OF FLORIDA
COUNTY OF__ _ �4 L�u.c_ P.
The far$oing instr ' ent was acknowledged before me
this �` day of 20 2I by
cl:i�rl
(Name of person acknowledging)
(Signature of Notary Public- State of Florida ]
Personally Known --OR
OR Produced Identification
Type of Identification I b
Produced�yl,LY� .��
Commiss,. ;a al)
otary Pubiir Sta,e of, ioripa f �' � lJ Z
' Commissior GG 340327
My Co rrr. S
r�2802.1
hf%!Jc
through ti
uora, tio[cREVIEW
,ry a5MANGROVE
1°SUPERVISOR
�COUNTREVIEW
PLANS
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 1/2014