HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E IN O MUST BE coV= rED FOR APPLICA'
Date:
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:
IAddress:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front.
St LucieC,
Building
TO BE ACCEPTED
'1 Permit Number:
Permit Application .� 'r 4
Commercial
— 13 4 - 00 l 0' 000—
�d -
Back: � /. Right Side:
IVA
�v
Residential �—
0 Left Side: 17, ` i
Lot No.
Block No.
r
O1,ff le PAY, Ig P�� 7 C+a �d /7 J''it'h f 6l t' 4 14 d ed e 4 ` el
r1'iv�c ( f e14
Additional.worK to be performed under tnis permit 7 cnecK aii tnat apply:
_Mechanical _ Gas Tank —'Gas Piping ..."Shutters .windows/Doors
_ Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq': Ft :of Co'ristruction: / %0 Sq. Ft. of,First Floor: 1 7!l 1➢
f
Cost of Construction: $ 5 s, rLf� UtilitieJ: _ Sewer _ Septic Building Height:
®UUNER/LE=-S�SEE:
CONTRACTOR:
Name_ �,��tl2A GCS
Address: q16 `10 CeA ja cd !"" ,ee
Name: L
Company: 4,p rrd i{g e eGA
City: F t . P" .efae State:
Zip Code: 'i i Fax:
Phone No. 7 7 2— 157
Address: _3 6 Al, Lt$
City: Eta rrFo%e State: EL__
Zip Code: ,f i 1_1 Fax:
Phone No f kt_ 6 6 12
E-Mail: /?
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail ,, . kc ►R-
State or County License 6,�e 1I" 71 rs
If value of construction is 2500 or more, a RECORDED Notice of
is required.
DESIGNER GINEER: _ Not/Applicable'.
Name: a VJ a ty ;/�rk Ir:�►i �.��''+ I ' AA d Q
Address_ Sn O- 044fe 90 e
City: State: FL
Zip`..�e{9� Q ,` Phone ?Z2-, --1399
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City' -
Zip: Phone:
ORTGAGE COMPANY: _ Not Applicable
flame:
Address',
City: State:
Zip: Phone:
BONDING COMPANY: Not. Applicable
Name:
Address:
City:
Zip:
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 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 recordinp, vour Notice of Commencement. _ a
ure of Owner
STATE OF FLORI
COUNTY OF
ntractor aslAsemt tckIDwner
STATE OF FLORIDA
a COUNTY OF
Holder a LL
U �
= O m d
ci vz
The % ping instrument was acknowled e The forgoing instrument was acknowle
this CA I day of 2 �a this o� l day of
a �U
(Name of person acknowledging) I1-1. 11 1 (Name of person acknowledging )
(Signature of Not�/r Public- State of Florida ) — P,
Personally Known � OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
of e a
by
co
. aA"m 9 V�-% P�ft
(Signature of Notaryblic- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014