HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /� -� Permit Number:
[T R
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: „,o�
c
PRQPQSED INPRQVEMENTLOCAT
ION„
Address: 10.701 S Oeeav, f,^ 7;` 7.2'/ JeN3e., &,.e/ , /�-L. y9 .
Legal Description: 0l%�ryye 0611- `O/-/50
PropertyTax ID#: 11511- SOF -0130 -000--;- Lot No.
Site Plan Name: VehX�e fAvee Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRtPTION CjF WORK , -
e%o I r7Lion an4l i-e.,vDI/Ql Ole 7 i'�J¢•% esu �:I�
I �o rG��i d'DOv�
CONSTRUCTION INFORMATION
Additionalwork to be pertormed under tispermit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 5By Sq. Ft. of First Floor: �L�y
Cost of Construction:$ 1700ce Utilities: Zsewer _Septic Building Height:
OWNER/LESSEE CONTRACTOR.'
I - .N.. .�
Name /1/e/for ��., ;57���� Name:
Address: /07 1' Oee4,? 50 'Company: �irirn Srf/ l�o�«7r �G-
City: 6 &,ofe4 State: Address: 6�/F IE J21-
Zip Code: 311 O 7 Fax: -City: —State:-/q.
Phone No. 5-7 1 Zip Code: j X157 Fax: 7,,2 232 2/y/
E-Mail: Phone No. 7.7,x- 2d0 J 7/.S
Fill in fee simple Title Holder on next page (if different E-Mail: ead/a^,Srn�'fh;hG a�
from the Owner listed above) State or County License: /02 6-/r v/
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
-P(A
SUPPLEMENTAL CONSTRUCTION LIEN LAUD INFQRMATION
�.
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 Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORI STATE OF FLORID
COUNTY OF � COUNTY OF , ,,,I
The fo going instr ent was acknowledged'�e me The for oing in ent was acknowledged bef re me
this day of 20Y this day of 20RA 14)
by
r
(rq
w• Vl
ame of person acknowledging) (Name of person acknowledging)
1 Y
(Signature of NotaryPub ' -State of Florida) (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known/ 0 Produced Identification
Type of Identification Prod T pe of Identification P�odq, _
os�a'r'P 6i,4 DAWN MILONE ! : ��4 NO��y AW�MILONE
Commission No. _r* �,�= § Public-State of Florid ommission No. a >.. M 9 81 State of Florida
-•• y Comm.Expires Mar 22,2017
Y'Comm.Expires Mar 22
_;�' #Jew *it ,� Commission .2017
,;,F Commission#EE 877571 n�i�" M EE 8
one rough National Notarylzaw_ A sn. rim ,...
9 y . � 571
t 0 atl nalNotarygsso
REVIEWS FRONT O 1 G LANS VEGETATION SEA TU RTI-117"iE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.