HomeMy WebLinkAboutBuilding Permit Application -All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: f'�`.222- Permit Number: /5V
s.
® 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: De,-o, 6oh
'PROPOSED INPRIZI MMEMT LOCATION:
Address: 5lleSj&fjHfieh6-1-a ,
Legal Description:_ole Lea Z/4.,/ %rIC. x,29,) " 2 Z,2
Property Tax ID#: 7 y D ' �Ql )0 V,3 000 `/ Lot No. �J
Site Plan Name: 11"rVii Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED D =�SCRIiPTION'OF WOR+K:
G cm ��fe '�i�Q/' 7 c� Qh' G✓ra � O f `3 ,��J f�DO%/ �7 0!�c YiG�
-'J v C®yrs.
CONSTRUCT(0 IiN FORMATION:
Additional work to be pertorme un er t ck all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: h5_5_
Sq. Ft. of First Floor: 5
Cost of Construction: $ Utilities: ewer _Septic Building Height:
01NNERjI=SSEE: C®NTRACT®.R:
Name L4ivn8:o9 c-e )1576,rt;ere Name: :.
Address. 5-1Z.33 144d-c~4 Company: � -5;; Y% _3 �Lc.. 1/ie.
City: k al t O i r� State:/Vr Addressid/1
Zip Code: �YO yz /Fax: _ City: �� ,' Stater
Phone No. '786`30 7 Zip Code: 31/5167 Fax: 772 23)--,2I�/
-Mail: IPhone No 7-7)- - 2 - 3.7 5
ill in fee simple Title Holder on next page (if different E-Mail R of q t" Sim ;-// i,o e e-X4 �•cum
om the Owner listed above) State or County License 6 ,Fe l S
Z ,'7Y
lue of construction is 2500 or more,a RECORDED Notice of Commencement is required. i�
S�' PPLEMENTAL.C®NSTRtIJCTION LI�E�I LAUV �'N�FOR�M�►1'I®N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: 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 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 re_Qerding yqw_-Notice of Commencement.
Signatu of Owner/A ent/Lessee/Contractor Signature of Contractor License Holder
STATE OF FLORIDA /( -/ STATE OF FLORID ,
A
COUNTY OF /� COUNTY OF
The for ing instrument wasacknowledged before me The f r oing instru ent was acknowledged before me
this day of 20 by this day of 20_ZS�by
me of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub Ii ate of Florida ) (Signature of Notary Publi -6 of Florida )
Personally Known of ation Personally Known R odu�e 'fication
m,
,'SPaY ', Type of Identification = i. �• __
Type of Identification .�° �;.,, l)gyyN MILD YP N D
Not'.
NE Produced • •a
Produced r �°= Y Public•State of Florida Gtory,P01/c
�
° Y omm.Ext %..hoo �a► st
p res Mar pp C, , f1,' ate
Commission No. �q
of Boa,• C kS�d�n EE 87757017 Commission No. Bonded "'Dnlres�
Bonded
h ouar a
9 National Notary Assn; hiodgh Nates�F'B�'S��u�� i
anal �
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROV
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014