HomeMy WebLinkAboutBuilding Permit Application All APPLICABLk INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED GO _00S
Date: ! � Permit Number: V
® _ 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:
PRfJPOSE9@1! EMTENI' L®CATI®N:
Address: O Liv S `� -c'1L �v-0
Legal Description: Lvy\(t L Lc,\—
Vvl .P /u Z w U %_C1 \ l
Property Tax ID#: 1 ,30 f (o0:2.- CSO d moo^ Lot No/7
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEl'APLE�® D�E�S'GRsI'�TI®N QF U1/®RK:
mamma
JCT10'N INf®RaIV1A�
itiona wor to a pe orme 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: aq 0D 6 � Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
C® A.OU1/=N"ER/LES=SEE Nl"RACT®Ft
Name ��ry ns-\ __-_ `� �r1 Lr �r� Name: 4- vL
Address7yd� C1v SC\L `9w Company: ti - rlc�Y�i t-
City: State,.k� Address: L/S,
3-' �r` 1 ✓Yt c_ S�
Zip Code: Cl.5 Fax: City:V State:(..,,
Phone No. Zip Code: Fax: ? cif'°I�)
E-Mail: Phone No 772- -567 r/ C,-?--=
Fill in fee simple Title Holder on next page (if different E-Mail 2
from the Owner listed above) State or County License C-L C/ J Z G 3 ) (3I
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPLEMENTAL C®NSTRIJCTI�I� LliN I.A1N INFORI\/IATIO
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 inVection. If you intend to obtain financing, consult with lender or an attorney before
commencing wpftdr regording your Notice of Commencement.Al
Signatur of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID '
COUNTY OF �� O COUNTY OF °
The fo going in ume t was acknowledged before me The for oing instr ent as acknowledged a ore me
this day of 20%�by this ay of 20�by
(Name of person acknowledging) r (Name of person acknowledging) `
(Signature of Notary Public tate of Florida) (Signature of Notary Public-St a of Florida )
Personally Known OR Produced_Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Producedroduced
DAWN MILONE �. N MILUNE
`v�Ppv gV64 2 ,`^a PPv p�,9
r°, .�'s Nglr ublic-State of Florida ;<,s; `�` Notary Publi�$ j�of FlMda-,
Commission No. _ 1 PP ommission No. 1x = - ` ,
•E My � 1�.Expires Mar 22,207 _ Comm.Ex Tres ar 22,2A17
Commission#EE 877571 9, Commission#EE 977571
y�R OF �•:
�•��ii!:.cfi%v �rPaLe�•
REVIEWS FRONT ZONING SUPERVISOR ' PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.