HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O —I^ /5 Permit Number: 1 ��
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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
PERMIT APPLICATION FOR: mo�f%�h
PRQPSED 1NPRQVE,MENT LQCATIQN.
Address: /0725- 5,' Oce,,,,, n `3 7,2n en 3
Legal Description: //OIiG��� u7'
Property Tax ID#: V511- 501 C r Lot No. 39
Site Plan Name: O�i�er5/ �/v7� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED-DESCRIPTION OFINORK
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IF
CQNSTRUCTIQN INFORMATIQN.:
Additional work to be performed under this permit-check a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing
L� _Sprinklers _Generator //_`Roof
Total Sq. Ft of Construction: •7�/ Sq. Ft. of First Floor: W
Cost of Construction: $ /790,00 Utilities: ewer Septic Building Height:
QWNER[LESSEE. CQNTRACTQR:
Name 19i1q,7,e 02 d- XD /4} q ,A ' Name: rr, ""7.,11
Address: 7607 /Ill Get A�f G�/. Company: m �rni'f� �O�C�d �i/c• ink
City: ._44e wollfA State: Address: �/ /✓� 2�«r �7�
Zip Code: V y 7 Fax: City: J—,ensem State: L
Phone No. 5ZI- 26/y- 031/ Zip Code: .3�19_57 Fax:77,;2-.2-3�-z�9�
E-Mail: Phone No. 77Z- 260 - 3715
Fill in fee simple Title Holder on next page (if different E-Mail: o cr,r7, f /,-o _ ca'"
from the Owner listed above) State or County License:
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
"SUPPLEMENT AL CONSTRUCTION LIEN LAW INFORMATION
.. „a.� _.
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 recordin ur Notice of Commencement.
Signature of Owner/A ent/Lessee Signature of Contractor/License Holder
STATE OF FL ORI STATE OF FLORI -
COUNTY OF., Q COUNTY OF
The forgoing inst u ent was acknowledged before me The forgoing inument was acknowledged before me
this day of 20y this day of 20_y
(Na of person acknowledging) 711 a of person acknowledgin )
1
a ure of Notary,ubli tate of orida ) (Signature of Notary Public-Sta o Florida )
Personally Known ,°o��N "F Produc en n Personally Known ; , ro uce Mtri atLon
Type of Identification °d � No AWN MELON Type of Identificatio P
°= =�`" oP�'MY^Comm Ex 'State of florida� �s' �: -MY Comm.E*,piies hoar 22,2017
1r `` „fs: 71
Commission No. r a,` Commj��S� f 9 MarpZ.2017 Commission No. Comm�See4 EE 8775
onra r,„cu^h�a. EE 87759 °0��4i 1� Bonded Through National�lotary 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
Rev.