HomeMy WebLinkAboutBuilding Permit Application All APPLI ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —� 0 167 Permit-Number: J �
-- _ 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: l j
PROPOSED ININV UEMiENT LOC«ATI4
Address: :W G ( I a Cr 0 U f r` r Cly`
Legal Description:
Property Tax ID#: \�`- �� –' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DfTILIE
D DEaS�CRIPTION OF V1/OR�f<: .
=@0@N6TRU----CTION IENFOR+MATIO'N:
Additional work to be pertormed uncler this permit–c ec a tat app I y:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ j Utilities: —Sewer _Septic Building Height:
OWNsE�'�L�E�SSEE: ._, COSI RACTO�R.
Name .,� 0 O Name.;.-
Address: 0 e r, Company:
City: i'e rC State:FL Address:
Zip Code: 3 4 g p Z Fax: City: State:
Phone NoC772–> q q d-- 12 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State orCo y License
If value of construction is 2500 or more,a RECORDED Notice of Commenc ent is required.
�UP�LEM'ENTA�L C®NSTRUCl'IDN LItE ! M ITOM, {MATIN
..,. .,.
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 authorizelthe'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.
3 rdi.0 e of Gw..—iei;Lesseej�lgent` Signature of Contractor/License Holder
i.
STATE OF FLORIDA ��C\ STATE OF FLORIDA
COUNTY OF 4P— COUNTY OF
The fq{g_oing instr ment was acknowledggd_Wore me The forgoing instrument was acknowledged before me
this May
of 20�by this day of 20_ by
Q)
(Name of person acknowledging) (Name of person acknowledging'TS )
!gnature of No ry Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced1clentification
Type of Identi iort- !`'�� Type of Identification
Produced ANGELA M HUFF Produced
NotarT-Public-State of Florida
"(- 4= Comml' sio4l# FF 234730 Commission No: (Seal)
Commission No. ry PAV Co IXC lfes May 27,201.9.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014