HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: /
a- -
M-018 I
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: To Select from dropbox, click here
'.PROPOSED fNPROVEMEI�T LOCATION _ -
Address: + e,
Legal Description:3,1(Q Yo 6 69 {tel' g5&R QFSW �i1q a W yy W,<rYy Aoz,7 S-'SO F! 77V
say e4-4b to r a 166 F+ 4A, s N asA 0-� w
Property Tax ID#:%5qc8-�m- r-ml~of —.,� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK`
• 14`VIt I 3L AJIMAM, M �
CONSTRUCTION INFORMATION• f_.. .
ditional work to b-e—pe-6ormed under this permit-cec al apply:
HVAC Gas Tank E]Gas Piping _ShuttersWindows/Doors
Q
11 Electric Plumbing Sprinklers 0 Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer Septic Building Height:
OWNER/LES$ E CONTf�AGTOR
:.
Name rA
/ Name- U �.
onn
Address: a,1/ Company:
City: � � State:�. Address: 4 I Y etwe
Zip Code: 2 Fax: City: �Or-t-l-rt��t'�2 r � �/S�taatee:
Phone No.���- ��-D��a� Zip Code:3�_ n2- Fax:_ b[.-` %_ 4
E-Mail: Phone No. I Q- Lk!5_1(06k4
Fill in fee simple Title Holder on next page(if different E-Mail: `I
from the Owner listed above) S to or ou ty License:
eQn e�
if value of construction is$2500 or more,a RECORDED Notice of Commence nt is required.
SUPPLEM)+NTAI,CQNSTU JQFV t1NCAW INFQi1 ►pfilb �
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: y _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 recording our Notice of Commencement.
Sigtfature of owner/Agent Lessee igna ure of Contractor/License Holder
STATE OF FLORIDSTATE OF FLORIDA
6ne)
COUNTY OF l COUNTY OF Q 1 Y t� CIS
The for oing inst ment %ORN4ryy)�d�ed before me The f r ing instr ent was acknowledged before me
this day of ill �� PL '9i=z-�by this day of 20M by
.1�" •\,y,2 a •. b0�' \ot Ntt!lltlrirrp�,,-i
Own Uel YZI
(Name of person aacn (Name of person acknowied$� . 5
y � e4�•,w=
01
(Sig ature of Notary Pu l - A616TTlorida j gnature of Notaryublic- 1i6%f
Personally Known I✓ OR Produced Identification Personally Known OR P14trt li ,-Cation
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE .
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED