HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE cvivIPLETED FOR APPLICATION TO BE ACCE D
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
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION,•
Commercial Residential
Address: D -11 5- a,) N-EA' ee.sea-RcAd CV RA FA 34514!C
Legal Description: 0n0ie'\ COBS S ID DS SS 3`I G /(-)o r+ 0� S 110f' Cass N ISM ��
La+ S i r
Property Tax ID #: Lot No.
Site Plan Name: ' Sb • wow. 000-1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:.
,d-'zn rPJ4 Y&'-1' F' Dlvt2 oc' n
CONSTRUCTION ]NFORMATICON
itiona wor to a per orme under this permit- c h ecK all that apply:
_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: $ 13'50Duo Utilities: —Sewer —Septic Building Height:
"OWNER/LESSEE: w
CONTRACTOR;:
Name 2 i f1- binSDn
Name:
UJ
Address:=15 elese�earch 0_4ir AZct
City: FA State: F
Zip Code: 3 14 CJ'Ll� Fax:
company:.�1�o�e�r�t�
Address: 1�1'�
City: Qyi
�� l� �C 9G I— S�
State: ;= r
Phone No.
Zip Code: 3` C° 163
Fax:
E-Mail:
Phone No---) -1 -'� -
9 60 -- ci' 6. �
Fill in fee simple Title Holder on next page ( if different
E-Mail 9h0-1-e_\ i)
c_ 10 4iw>1 CDv'x
State or County License @e e- 1 1"S 1►'10
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
77 �
SUPPLEMENTAI. CONSTR';UCTION LIEN I.AW INFORMATION s
.§ S.
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY. _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
y
Zip: Phone: _
FEE SIMPLE TITLE HOLDER: _Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: `
City:
Zip: Phone: I
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 thattJs 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.
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contract as Agent for Owner
Signature of Contractor%License Hol
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY.OF 5.1_..o .
The forgoing instrument was acknowledged befbr me
this Il day of 20-J-) by,
The forgoing instrument was acknowledged before me
this day 20_ by
of
4
(Name of person acknowledging) {
m
(Name of person acknowledging)
i
(Signature of Notary Public- State of Florida) ;
(Signature of Notary Public- State of Moricla )
Personally Known OR Produced Identificlati
Personally Known OR Produced Identification'
Type of Identification
Produced f L {M
Type of Identificati n
Produced FN.-
Commission No. (Seal) ;
K
Commission No. I- (Seal)
REVIEWS
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
RE�,RVISOR
IEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
r
DATE
COMPLETED
Rev. 'I