HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETI_ _:'.-°OR APPLICATION TO BE ACCEPTED `
Date: a ` 13 11 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application DEC $ 201.7
Commercial Residential
PERMIT APPLICATION FOR: .<0 Dt • - - ,N d `
Address: 049 At • EL MAP- -� R
Legal Description:
Property Tax ID #: S66) - w 62- "- (n�cb Lot No.
Site Plan Name: Block No.
Project Name: # w/- 14cole
Setbacks Front Back: Right Side: Left Side:
ditional work to be pertormed under this permit -check all that apply:
_Mechanical _ Gas Tank - Gas Piping _ Shutters
_ Electric _ Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction: 6 6C !"�(i®1/4 Sq. Ft. of First Floor:
Cost of Construction: $ dt — Utilities: —Sewer _Septic
_ Windows/D ors
Roof �Z Pitch
Building Height:
OWNER%LESSEE:
CONTRACTOR:
Name. lllfl -901 ag /tPb `�rL� -
Address: #' ��v N- L04' bk,'
Name:
Company:
Address:
City: 4o3scem StateoEL
City: State:
Zip Code: Fax:
Phone No. to 712
,, `'.j- /17
E-Mai1: 90 /L ` eo
Zip Code: Fax:
Phone No
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.
{
SUPPLENff-�NTAL CONS U'CTIG7N LIEN I.A OTISNJ
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name: ...
Address: I
Address:
City: State: I
City: State:
Zip: Phone 1
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: 1 Address:
City: 1 City:
Zip: Phone: 1 Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applicationis 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 such
prohibit
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 Code's 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 ofCommencementmay 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.
5igpkurelofi0W e e see/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5% . Lyc Vk
COUNTY OF
`
The forgoing instrument was acknowledge55before me
I
The�forgoing instrument was acknowledged before me
this\3 day of 'OR, C 201! by
this I day of , 20_ by
Name of person making st tement.
Name�of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of{Identification
Produced f-L- L
Produced
(Signature of Notary Public- S #�F �EGIVENS I�
(Signature of Notary Public- State of Florida )
. , , DEANNAMAR
ISSION # GG 07202�
Commission No.-Ak M•pecembet16,26^0
Commission No. (Seal)
9 Bonded Thu Notary Public Unaen�'den.
4rFOi P ��••
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
',VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
1