HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ct/ I Permit Number:
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
PROP05ED INO d tMENT LOCATIONAl
Address: 5508 51L_vER 00M Df2 FOM P►EeCE, FL, 5 4982
Legal Description: JUDIAN IEI V'2 STAT�S
Property Tax ID#: 3g02-A6O 7—0Zd Z-000- Io Lot No. 13 AUD l�
Site Plan Name: Block No. Z-3
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK `
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2EPc,aCE S I r%PXCr W 11,.LDOW5. 512E FO2 517,E
CONSTRUCTION INFORMATION q
Additional wor to be nertormed un er t is permit—c ec a appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �,5g I Utilities:InSewer Septic Building Height:
OWNERLESSEE
a CONTRACTOR
Name 140 P3T 1-VDU-)lib r C me: 15.7pNNIE T- ,BUV_W EfT"
Address: -5-506 51(L- rT C*P Com- • Company: FL000A W`IE Ir'IP(MvE-ricin
City: FOOT State: FL Address: 4010 gW - 30 PME.
Zip Code: ,34982 Fax: City: 44o"iwoofl State: FL
Phone No.__)7 Z •`i(oJ- 550 l Zip Code: 33.317- Fax: y01'477-8380
E-Mail: Phone No. q54• '1gZ4415 x-LA?j
Fill in fee simple Title Holder on next page(if different E-Mail: P: PVMIA-5 e F AQPvOdO045• corn
from the Owner listed above) State or County License: C C-,C OCP 184(-)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
�
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 thepermit 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.
ignature of Owner/Agent/Lessee ontra Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5r- L-vC%E COUNTY OF 5T - L_QUE
The forgoing instrument was acknowledged before me Theforgoing instrument was acknowledged before me
this_.Z> day of JQW-E 20L=by this3 day of JO LVE: 20®by
4-I=1— V.DW 1120 UJPy N I. ove4.rerr
(Name of pe son a knowledging) (Nam of erson cknowledging)
( ' tur of Notary Public-State of Florida) ature of Notary Public-State of Florida)
Personally nown —' OR Produced Identification Per nown x OR Produced Identification
Type of Iden ification Produced of Id tification Produced
Commission No. (Seal GPRGgS� aQ o. �Z (Seal NFy 1,
-opP.�'e'a"e'[,�*. ��X@P�SNo eub\\cUn •.�:Y•.., GP�����NE23920•
:+• ,� Goode _}' c* �XQIP�S•NotaN Publ'w�n �;,;.�.i
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED