HomeMy WebLinkAboutPERMIT APPLICATION LLANAS 1All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION:
Address: F4 ' _� L_ 8
Legal Description: t95— C_ r�- Al
fl/�t A N) �U V4 s L j a�� LA&-)
Property Tax ID #: 2 VQk Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DESC21PTfDN &
DETAILED ry
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. --...+u_,� � �' '�'�v-$�S:$4 ff� � �_ �,iic'`�'�'�� ' �,.0 S �L ,3`a rp �✓!' "vv �f s,.. r y
r.
CONSTRUCTION INFORMATION:
Additional work to be per orme un er t is permit - c ec a t at app y:
_Mechanical s T _ Gas Piping _ Shutters _ Windows/Doors
:71um_ Electric bing _ Sprinklers _ Generator i Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
O NERAESSEE: H<
CONTRACTOR:
Name:
�srt� �c r1
Address: C2
Company: o
City: /e - d r� State: ��
Address: CJ 1� 6 r d
Zip Code: �_3219V 7 Fax:
City: � ,'e r State:__C�
Phone No. -7 7 / , -�U�
Zip Code: 34q, k- _�-_ Fax:
E-Maik— 0 0 i_g,
Phone No �7 Co - ' Z-
Fill in fee simple Title Holder on nex age ( if different
E-Mail `�`_ rt ;q JA
from the Owner listed above)
State or County Licensez je-- r
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not App
Name:
Address:
City: State*
Zip: 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 indicateo.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Count, 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 JOB SITE BEFORE THE FIRST ONSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."_ --
i
Signature of Owner/ Lessee/Contractor as g nt for Owner
Signature of Contractor/License Holder
i
STATE OF FLORIDA
4. )Ai
STATE OF FLORIDA� J
16
COUNTY OF , (14 C'.
COUNTY OF 1A
The forgoing instrqMent was acknowledged before me
this day of I V ` 20aI by
The forgoing instr ent was acknowledged before me
this � day of _ __, 20 1 by
—�
Name of person making stiitement.
Name of person makings Cement. j
Personally Known 0 OR Produced Identification
Personally Known —(-- OR Produced Identification
Type of Identification L
Type of Identification
Produced
Produced )
y / L-f'
(Signs sire of Notary Public- St
nature of Notary Public- State of
otNT'W, Notary PuC;+c State of Flontl
Commission No. ; = r sa L Butterfield
} � ' v{fit pmm uion GG 302065
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C mission No. i U f <'i E3l�A`,
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE.
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
_
COMPLETED
,
Rev. 2/7/19