HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED
Date: -�lr) -�� .� 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
PE RMITAPPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: y L„2 w"� l-- 0060 - 000 - 0 Lot No.�
Site Plan Name: l/i j+c3g- Block No.
Project Name: IAJI/�� ® �� o Z47 �-
Setbacks Front Back: Right Side: Left,Side:
Additional work to be perrormea under this permit-checK all that appy:
.:Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_.:Electcicmbing —Sprinklers Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ � ,-CSU Utilities: _Sewer _Septic Building Height:
Name %V1
9 2 Name: <,,:h e�
Address: ON 13aJ�1�OZ Company: Mj 12 u
City:® jc gA,-� /eieere State: Address: P62 /3v-,X 13eZ
Zip Code: Fax: City:� L� y/� efo�- State:dr�
Phone No. Zip Code: ? V% Fax:
E-Mail: Phone No -7 7 2
Fillin-fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Z"
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
3
DESIGNER/ENGINEER: `Not Applicable MORTGAGE COMPANY: u 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 arid 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 recordi, our Notice of Commencement.
Signature of Owner/Lessee/A t Signature of Contractor/License Hol r
CC
STATE OF FLORID N m STATE OF FLORI 0-��
_ x� 5
COUNTY OF4 * COUNTY OF =" :a
CM
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The for oing ins% ent was a knowledged be rg r8l a The faj ing instr ent wa-acknowledge to 9!1CC 2
this day of 20�.�b m� this L day of 20 `by i3a.
Mw$ M
o r� m
8a .j// /fit ..a,,. '
1 /I ` �� ' V V Fadi#•Y%9
(Name of person ackno ledging) ..,,, (Name of person acknowledginhO
(Si122gly LAW W-14L A i I NZ, 9
gnature of ary Public-Staff�te of Fla a} (Signature of Notary Public-State of Florida)
Personal) Identification,
Personally n OR Produced Identifcation� Y Known OR Produced Identi
Type of i. ti 11C ti <r Type of I bffi tin
Produced s_.� Produced
Commission NP (Seal) Commission N (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW. REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014