HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETeu rOR APPLICATION TO BE ACCEPTED
Dater S G A�� Permit Number: 1 Ada.- dd a
BY
... _ M Lucie County
.�............�.............. .......�.��.. .. 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:
Address:
Legal Description:
M PbAF 8
Property Tax ID #:
Site Plan Name: _
Project Name: _
Setbacks Front
V—V )0 0v1- P holS2 11A
(03 C -/1J& ew20l2la-,
1391- OS-��-06a -
r'eseav-e JeA" U'A
Back: Right Side: Left Side:
Lot No.
Block No.
j 5})q-114gA
'Y` Gv�S
4-1WM('n.L(PA *ice , �-k 3 Y _,
6*A7FtS 71yl97
S1-1,,ELt--
G4,0CC S'EG,F^ b497c-A-1
Haaitionai worK to oe perrormea unaer tnis permit — cnecK an tnat 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: $ '2 Utilities: —Sewer _Septic Building Height:
011UNER%LESSEE.
n
CO-NTRACI'OR � .
Name• ,r
ln�
Name VI' Cec/l I�VIf®'�LC�2 (r/t�
Ad"dress::�a97� IAdAt1JANl
City: 0 " �•S'�N�rC�e'tCl:�
State:
Address:
Zip Code: 3Wcs'& Fax:
City: State:nf-
Phone N t
Zip Code: 3q�2 Fa
- PdE-Mail: 5
. of0VV1
Phone No CtSN -! ti f C)
Fill in fee simple Title Holder on
next page ( if different
E-Mail - Pp' o
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
4777
F
t „k
gSLPPLEMENI"Al CQN�TR CTiN LIEN �:AW
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
'Name:
Address: I
Address:
City: State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: I City:
Zip: Phone: Zip: Phone:.
I
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 commen,� ced prior to the issuance of a permit.
St. Lucie County makes no representation that islgranting a permit will, authorize the permit.holder to, build the su,,bject structure
which is in conflict with any applicable Home 01vs,iners Association rules, bylaws or'and covent nas'thaf.may �dstr'ict 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 cJo 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.
i
Si ature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA ,., : -. , .;,STATE
OF.FLORIDA I =
COUNTY OF . In
COUNTY OF
The for oing instr ment was acknowledged efl re me
this �� day of 20b�i
The €��g ing instru ent was acknowledg efore me
this l ll��ay of / 20Jby
�� �� 11 y%C �
U, 0 nyl l� V° I I� 1/� 1nd
(Name of person acknowledgin
(Name of person acknowled ' g)
:il
(Siena ure of Notary Public- State of Florida) I
Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific 'on
Produced �- CE LORIN BRADSFIA
Type of Identification BRICELORINBRAD
Produced NOTARY PUBLIC
)VNI TARY PUBLIC
_ STATE OF FLORIDCommission
No. OF FLORIDA
Commission No: 00005979
on m# GG005979
020
EMPt 918/ m
REVIEWS
FRONT
ZONING,
SUPERVISOR
PLANS
VEGETATION.
SEA TURTLE -
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW .
REVIEW ' `
REVIEW
REVIEW
DATE
�/Z�
RECEIVED
DATE
COMPLETED
iev.7/2014