HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED //,,
o
Date: ��ii � Permit Number: ��� V'
• r
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't?P®SED 1NEPROVEMEN LOCATION:
Address: '225 -Tk �(-I i4Lisr� [
Legal Description:
Property Tax IDt# � 13-�� ASO l�'�(�C)6-7�C OC) �' 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
MR
DE? I3 ®EDSET ® ONNA ,
Jq `
-KaeCc\Q— 1 cQ
=COWST�LUr§-TFl(6, =§I[NN,; 1/IA1'I®N.
Additionalwork to be pertormedd under this 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: $ 2 BOG -C Utilities: —Sewer _Septic Building Height:
OUV�tV,ER%L�SSEE _ = �� CONTR�►CT®R
F.
Name Name: Ya.
Address: -R-1 .Al M►LI-AM TV-AIL Company:`N�'�U-
City: ej'£ci, Stater Address: `—d'1 S'� ��f.ScL -t7�--//-
Zip Code: 1 d Fax: f city:i. S� LuC.�E. State:�z
Phone No. 9�� rf'21.� 'Q8`l 3 Zip Code: Fax:-777--3 -1 3
E-Mail: Phone No 212 --337-- L11 C
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License fG 13 a
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU`PP'LEMENTAL CON�STR±l1CTION LI l �W ' F®RiMATIO.N:
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 hon'=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 inten to obtain financing, consult with len r or an attorney before
commencing work pr r ordin ouf. otice of Commencement. %
Signature of /Le see/A ent Signature ractor/licens`e Holder--
STATE OF F RIDA �� STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrAnent as acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of„ / 20_ by
(Name of so ckn, ping) (Name er n ac dging)
(Signature of Notary Public-State of Florida) (Signature of Notary Publid- tate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Iden ifi ti Ol
Type of Ide ifi ation pe of Identification DAWN MILONE
y DAWN MILONE
a� °' P duced o•ar P� y Public-State of Florida
Produced � ,••o�°' h,'-, _ .�P 6''-:
Nofary Public-State of Florid a. My Comm.Expires Mar 22,2017
-'« _ -IMI y Co m.Expires Mar 22,20 7 .mmission No. NQ :pec Ca(iS®es�lon#EE 877571
Commission No. ;# "a`c f oP,
a ( mission EE 877571
��, �;,����• 'iP OF.F���• Bonded Through National Notary Assn.
Bonded Through National Notary As ri. """��
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v.