HomeMy WebLinkAboutBuilding Permit Application ALL APPLE BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
L Permit Number: l
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 wV/
Residential
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED IfPROVEMNT LSC; IONS
Address: k \
Legal Description:NLI®nA � afi] uhreay'G'�e 6W �C6tiys, 3J QAd
-Itss 1Srf`^t� W to dvr5� 6-1a Ict f �- S
Property Tax ID#:
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAfLED DESCRIPTION OF WORK°
I
Ai V Ve'
^LA
_
�&fflionaworktobaoerrormed
un er# is permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping —Shutters Q Windows/Doors
0-Electric 0 Plumbing Sprinklers 0 Generator O Roof
Total Sq.Ft of Construction: S .Ft.of First Floor:
2
b� Utilities. Sewer of Construction:$ Septic Building Height:
OWNER/LESSEE
C
ONTRi4GT'OR
Name �6e- Name: u�
Address: (0A Company:
City: State:EL Address: 0 e—
Zip Code:slt�45 Fax: City: Y4- State:c tc�
Phone No.rl r1,967f7 q - Z4(00 Zip Code: q Fax•q�-72qQL6
E-Mail: Phone No. rrp-
Fill in fee simple Title Holder on next page(if different E-Mail:nAC�'rm`r1��,
from the Owner listed above) S ate or ougty Licens:� 1 (O
Ulft LA"
if value of construction is$2500 or more,a RECORDED Notice of Commencem nt is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.Luciepounmakes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict ict with any applicable Homeowners Association rule;,bylaws or an 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.
I
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 your Notice of Commencement.
1 �rtg6afureofOwner/Agent/Lessee /fthature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA,,
-
COUNTY OF__
Ot eJ _ Cowry OF
The g instrqment was acknowledged before me The fnro 'ng in meet was acknowledged before me
lay Elay of 2(])KJ by this gay of. n4—P .26_Wby
( ')Oilwd 7�:)UrKa"A ham
(Name of person acknowledging) (Name of person acknowledging)
e�7
f(Signature of Not;iry Public-State of Florida (6ignature of Notarf"Public-State of Florida
Personally Known 4c,
9AINQ fication Personally Known OR Prod*-d I
—_� *_ �
Type of Identification Pi _A6&',_s 11;4�:��Ilk Type of Identification Produced 'Z
Commission No. Commission No.
*.Inn
1V
Revised 07/15/2014 AIR ..�Q' _01 ..14V
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
-RECEIVED
DATE
J,[:CdiipLETED