HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IlYFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
L Permit Nu �,J
Date: `7 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:
Address: P?bol Ea)o ?wCCJ Gkf N
Legal Description: DAi(AtIt� neg e)
Vilf)- pha5b t- u)+
A
17�>
Property Tax ID#: Lot No.
Site Plan Name: Block Na.KJA
Project Name: 1 lkd(A�W
Setbacks Front Back:- Right Side: Left Side:
LaStall Ile f6f !f like- ck
I A-aae . Abor
Additional work to be pertormed under this permit-check all that appy:
_.Mechanical —Gas Tank i Gas Piping r Shutters ",/Windows/Doors
—Electric —Plumbing ^Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
"N I I �,o
Cost of Construction:$—CN Utilities: —Sewer _Septic Building Height:
NameAlaPidavcoh Name:
I
Address: 15,60-1Tkne_s
o Company: MM En rise oC &e_wd
City: Fby-+ Pit;v-rin State: FL Address: 0015 T>/
Zip Code:NC4)I Fax:_tqlA city: Indian Aa.bvu, i0ie-C%-, State:
Phone No. Z)4t J- Zip Code: 3Z�%3_7 Fax: 32-1-777- W3 q
E-Mail:. Phone No. 772-337-41zl7o
Fill in fee simple Title Holder on next page if different E-Mail: bi4e5sh4upy)AP Vakmp- <-o,,A
from the Owner listed above) State or County License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State:— City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: V 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
commenging work or recording our Notice of Commencement.
W11141 _14-AIV-1,111 'dol'� _�'&1 �
Signature of gllwner/Ag�en/Lessee Signature of Con octor/LicenseHolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �V&4 COUNTY OF ig ce vzu_4
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of M.4,1 201 S by this 41 day of M7q4� 20 IS by
eo fv_ SV-w_,J
(Name f person(lacknowledeing) (Name o of p 1,
:T11i n acknowledging)
(Signature of Notary Public-State of Florida (SignatA of Notary Public-SfaVe of Florida
Personally Known-V" OR Produced identification Personally Known OR Produced Identification
Type of Identification Produved ,--4
Type of Identification Produced
Commission No. (Seal) Commission No. (Seal) ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
-COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW -REVIEW.
DATE
RECEIVED
ATE
COMPLETED -J
Rev.7/2014