HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- t
ALL APPLICABLE INFO MUST BE COMPL-reW FOR APPLICATION -TO BE ACCEPTED
Date: ,N -::� Permit Number:G AS
Building Permit Application DEC 0 1 2011
Planning and Development Services
Building and Code Regulation Division m .............oe...,,,,,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1//
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line �Q1
PROPOSED IMPROVEMENT LOCATION:
Address:Legal Description:
Description:
Property Tax ID #: t.4' lci o0c,> / 7 Lot No.
Site Plan Name: Block No.
Project Name: er2�21c;�
Setbacks Front Back: Right Side: Left Side:
DETAIL'ED'DESCRLPTION OF 1N0RK
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CONSTRUCTION INFORMATION:
Aaamonai worK to De errormea unaer tnis permit— cnecK aii apply:
OHVAC _ Gas Tank ❑Gas Piping . Shutters Q doves/Doors
Electric ❑ Plumbing Sprinklers FIGenerator _ Roof Roof pitch
Total Sq. Ft of Construction: a�OD S . Ft. of First Floor:
Cost of Construction: $ o Utilities:li Sewer E]Septic Building Height: 2 ::2 —
OWNER/LESS;EE.� ' "CONTRACTO'R
Name IA-31 1 .A-4-A RM2
Name:
Address: ZCt 31:A��
Company:
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City: ` - �i _G State:
Address:N:;�i<:Ac2n d5�LA.�' Ai/C
J Wit_
Zip Code: ??,Aq 1�3 Fax:
City: GL
State:
Phone No.
Zip Code:�l� dl Fax:
E-Mail:
Phone No. `� 'Z ^— _3,4 4
Fill in fee simple Title Holder on next page ( if different
E-Mail:
State or County License: Q
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of*Commencement is required.
G.
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TAL-CONST
SUPPLEMEN•
:. .
-CTION LIEN LAW,INFQRIVIATI:ON.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Address:
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 Dome 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 plains, 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 properfy. A Notice of Commencemea 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
r_ommencine work or recordinl� vour Notice of Commencement.
Signature of Owner/ Lessee/Contr
ctor as gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
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STATE OF FLORIDA
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COUNTY OF V
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COUNTY OF
The forgoing instru ent was acknbwledge
this � day of R �.
before me
2011 by
The forgoing'instr ment was acknowledged before me
this \ day of 20� by
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t"laes
Nam of person m king
statement
Name of person mak ng statement
Personally Known OR Produced
Identification
Personally Known OR Produced Identification
Type of Identification
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Type of Iden ificat'on
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Produced t-
Produced
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(Signature of Notary Pu ic- State
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(Signature of Notary P lic- St �1VEP1A�
9 p NpMARIE ®Qg� 025
Commission No.
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PLANS
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SEA TURTLE
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REVIEW
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
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DATE
COMPLETED
Rev. 8/2/17