HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE Permit Number:
Date:
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:
�PR&OSED INPROUEMENT LOCATION
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Address: W150'), ���(GFXyz>
1 ,Legal Description: La4 R EW 0 tb D Pte:L iJ N l F 'R Z-07-5 16417-
Property Tax ID#: / 'C� - U ' G G U a Lot No.
Site Plan Name: �Br8'�- Block No.
Project Name:
Setbacks Front �6 Back: Right Side: 7® Left Side:
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DETAILED,DESCRIPTI.ON OF WORK
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,'CONSTRUCTION INFORMATION:
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iUona wor to ape orme un er t is permit-check all that appy:
_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: $ q(3 00 Utilities: —Sewer —Septic Building Height:
OWNSEE
CONTRACTOR
ER LES
Name 0 R D A) Name.. 1
Address: L XF Ll
4fl PS LU-0 Company: �`` C�r i�-f `
City: J�J l _ State: F�L. Address: I Jpr
Zip Code: .3 V 5-1 Fax: City: -r tOa,,, State:_z_t7
Phone No. Zip Code: r� Fax:
E-Mail• C; ��iJ i VAS r /y T Phone No. 7 72 Zo/ ?3 7P
Fill in fee simple Title Holder on nextage (if different E-Mail: c� u
from the Owner listed above) State or County License: ! Z 6/ e 6C Aad
If value of construction is 2500 or more,a RECORDED.Notice of Commencement is required.
SURPLEIUIENTAL CONSTRUCTION LIxEN LAIN INFQRMATIQN
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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 ur Notice of Commencement.
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Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA4 STATE OF FLORID , {
COUNTY OF S COUNTY OF
The for ing instrument was acknowledged before me The fo oing ins me was acknowledged re me
this,. y of ��'lk, 20� by this �day of 20 by
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(Name of person acknowledging) ( erson acknowledging)
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(Signature of Notary Public- to of Florida ) (Signature of Notary P blic-State of Florida )
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Personally Known OR Produced Identification Personally Known Q"1 ',,P-roduced Id p1LONE
Type of 1�",I i P o c d 2iao- qa-5 — Type of Identification P od,,e` NotaryPublic-State of Florida
P ,, •'� My Comm.Fxpires Mar 22,2017
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( ) +'t Com�rgl) EE 877571
Commi i ° .�: Seal Commission No.
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REVIEWS ,SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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Rev.712-014