HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ld
�/� 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:
PROPOSED I�NPROUEMENT LOCATION:
Address: 'eor
Legal Description:
Property Tax ID#: / , !��(� .7 y Lot No.
T
Site Plan Name: Block No.
Project Name: Einem r�/�vrcV sir U•c (, d1�r,®
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SGR�IPT ON OF WORK:
iyJeY�en�v jeeA2 /". lee elec4p c S(?ryi�
CONSTRUCTION INFORMATION--:
Additional work to be pertormed + under this permit-check a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
lectric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ ��®• Utilities: _Sewer _Septic Building Height:
OWNER/LE=-S�SEE: CONTRfACTvO'R:
Name We n�i An,�f�n ar>e Name:14/1 lyse Ele,dr,.'C C`end(l4G'71/'s _n 1,
Address: Company: jej4
City: a�� �/�r c r °'.-. . State:�G Address: 61l/
Zip Code: Fax: City: ��' �,'�rce State:-El-
Phone No. Zip Code: 9 Fax: GS���?S"�'
E-Mail: Phone No.470- �7D
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License G OS'Oa7�y—
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI®N LIEN LAW INF®RMAT40N:
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 recording our Notice of Commencement.
Signat re f wner/L ee/Agent Sign re f ontract 'License Holder
STATE-OF FLORID STATE OF FLORIDA -,r--
COUNTY OF COUNTY COUNTY OF `JC1il
The fo oing instr pent was acknowledged b fore me The for oing instr ment was acknowledged before me
this day of 20�y this 9day of 20/T by
Q,
67f Jperacknowledging) (N e p so a owledging)
'�_
(Signature of Notary Public-State&f Florida) (Signa ure o otary Public-State o lorida )
Personally Kn tions Personally Know OR Produced Identification
" � DAWN MILONE T e of Id ifca on "'�'�
Type of Ide t Iced P�e�;, Type o"Rr'.;;
Produce
r .�; Notary Public-State of Florida Produced o�' y DAWN MILONE
S 9. • - Mar 22,2017
, - �:�' Commission# E t3 7571 ; r, - �'State of Florida
Commission o.'%OF.F����� €Q 1 Commission No. 9° :�P M`'Comm.Expi �P2 2p17
--B...ae^^a•'Through Natidn'd gPary Assn.i' of Fro 6ommission#EE 77571
""""`� Bonded Through National Notary Assn.
REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.