HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��
Date: Permit Number: 1505 66
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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 1�
PERMIT APPLICATION FOR: C�/
Address: 0 &v I O 1TSI(J"L, '_
Legal Description: 15 �� � �+ , S �j LK ( L-6 i
Property Tax ID#: 3o(, -S'00 `d (o C-OrJ0-3 3 7 9P Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: ight Side: Left Side:
G"h- d a V-
Additional work to a pe ormed un er t is pe mit—c ec a tat appy:
_Mechanical _Gas Tank as Piping _Shutters _/Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ? _ Utilities: _Sewer _Septic Building Height:
7Address:
�2 S Name:O Company:
City: i e�c_Q_ State:_ Address: a 1� � ) 9
Zip Code: a��( Fax: City: 01- to-i-410 d Stater
Phone No. _722-- 5_0 &I Zip Code: `L) 1 0 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if di#ferent E-Mail: 3Z('7,43.0(03
from the Owner listed above) St e or County License: 'SZ ry( 7
Lfvalue of construction is 2500 or more,a RECORDED Notice of Commencement i6lecluired.
SUPPLEMENTAL CONSTRUCTION"LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Ap i Iicable MORTGAGE COMPANY: _ Not Applicable
Name; Name:
Address: Address:
City: Sate: City: State:
Zip: Phone: Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: Not Ap licable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: I Zip: Phone:
I
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is gr nting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owne s Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners sociation and review your deed for any restrictions which may apply.
In consideration of the granting of this requested p rmit, I do hereby agree that I will,in all respect perform the work
in accordance with the approved plans, the Florida uilding Codes and St. Lucie County Amendm t
The following building perm' plications are exempt from undergoing a full concurrency revie : r m additions,
accessory structures,swi inJur
pools, fen es,walls signs, screen rooms and accessory uses t ano er non-residential use
WARNING TO OWN R:Y fai re t Record a Notice of Commencement may r suit' your paying twice for
improvements toy ur pr per . A N tice df Commencement must be rec r 0 ed a d post n the jobsite
before the first ins ectio . I you int nd to btain financing, consult with I der o an a orn y before
commencingwor or rec din You
NoticO of Commencement.
Signature of Own /Agent/Lessee Signature of Co ntr .tor/License Holder
STATE OF FL IDA STATE OF FL? DA
COUNTY OF .INCE COUNTY OFcH +GE
The forgoing i strument was acknowledged before me The forgoing ins ument was acknowledged ore me
this_day f 20 14 by this_day o 201,1 by
PETER A CAFAR6 III 1 PETER A CAFARO III
(Name of person acknowl (Name of person acknowle ing j
( ignature of Notary Public-State of F orida) (Si nature o Notary Public-State 6f Flor da )
Personally Known x OR Produced Identificatin Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
fr ��
Commission No. EE 174164 mmission No. EE 174164 rpt NotL I-cStateof Florida
°fir PLq` Notary Public State of Florida q 'Gc {
_ ^ Kari M Ricc boni Kari M Riccaboniirsslin EE 174 113- j
7 c Y fA Commission EE 174164
Revised 07/15/2014 ? xpires 05128 2016
of r�° E=xpires 0512812016
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