HomeMy WebLinkAboutBuilding Permit Application .All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date: S S IS 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 Commercial Residential
PERMIT APPLICATION FOR:
PRQPQSED IN.RR01(EMENT:LQCATIQ.N t
Address �� _ 166or\ twee /4- ..S4 -IC,f
Legal Description:
Property Tax ID#: 3y 22 01 QQ1 — 000 --k Lot No.��
Site Plan Name: Block No. f
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPfTION O:F WORK
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CONSTRUCTION INFORMATION
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Additionalwork to be pertormed under this permit-checR all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 17,00-00 Utilities: —Sewer —Septic Building Height:
OWN ER/LESSEECONl'RACTOR.
Name,,
f,;+�li e�2 '' E1r�,cn Name:
Address: ZN� Company:""• 6n�c Co'-Amc'4-e's Co' port '-In
City: 5U4 lr�ci0- State: Address: 1q-7Z 3e Cc. S(-.
Zip Code: _ 14GY3 Fax: City: '�o. , 't L.46e State: FL
Phone No. i-&0\4 - 512- �7 4-)5 Zip Code: N�'& - Fax:
E-Mail: Phone No. 2-72,- d 07- Zisl l
Fill in fee simple Title Holder on next page (if different E-Mail: &n1P (c� G tea:r. Ccs
from the Owner listed above) State or County License: C_ ) k8 0 S'
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTI N LIEN LAIN INFORMATION - y
/ pp MORTGAGE COMPANY: _Not Applicable
DESIGNER ENGINEER: _Not Applicable le
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 recording our Notice of Commencement.
Signature of Owner Agent/Lessee Signature-of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF C COUNTY OF C
The fofgeing inst wa acknowledged befare me The forpimg instrumeQt was acknowledged before me
this 0 day of 20_/,)by this J day of a%' 20_/_<�3y
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(N o person acknowledging) (N of person acknowledging)
(Signature of Notary Publ' -State o rida) (Signature of Notary Publi ate o Florida )
Personally Known ORVrq#0&1d,JdentificatftWN MILONE Per nally Known OQJRrpduce Iden ^_
Type of Identification Produce =°v" Notary Publ(c-State of FI r1p of Identification Pro MIlO1�E
W Comm.Expires Mar 22,2017 ° •=My Comm. ° lorida
-�` ommission�EE 8775 �' " Q €xPires Mar 22;2017
- �o mission No. %'F °a°' C ��$�ion�R EE 877571
Commission No. a ':;; ;;,{�eal� BondedThrou h
Bonded Through National Notar Assn. g National Notary Assn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 2014