HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1l \S Permit Number: l 41 01 d3
RECEIVED JUL' 0 7103
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: s�, a \
Address:
Legal Description:_ t/l h i 1 G 03 e- g' _
Property Tax ID#: 14c) ) C7� Q oo I nn U 5 Lot No. .
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
� ^ kit GP\ C�
Additional work to be performed under this permit—check all that app y:
_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:$ 1 , UL Utilities: _Sewer _Septic Building Height:
t.. _
OISE
cName` . i� 'r i�3 hs A : �,TC + � Name: r. �^ f /N-i v� C 47 G
Address:j ° ,Lf.
, 0 q p'r'.}( ^" `l r T 430- Company: '�o l �r '�'ranC'n Sc Cc, ,fir
City: f `T P 1�+ �� State: Address:
Zip Code:: '3'(T%2- Fax: City: E 7L State:
Phone No. Zip Code: 7 C('T Z 2, Fax: '7-L C(il
E-Mail: Phone No "1'71 �[ `15' 3 cl G 6
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License (('C 1 3'11 OL
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 thepermit 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 our Notice of Commencement.
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Sig re of Ow er/Lessee ent Siguffure of Contractor/L' se Holder
STATE OF FLORIna STATE OF FLORI
COUNTY OF C 1_>3 c S, COUNTY OF t*T- LU S 1-Q,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of J-- ,20 6y tfiis day of _JX� ,20_ by
01t� v� D � �'( a.r c Q. 5 Z.O 5d�n fi►. �i�'C q,1n,Ct S'�-O
(Name of person acknowledging) (Name of person acknowledging)
{Signature of Notary Pub -State of Florida) {Signature of Notary Public tate of Florida)
Personally Known °' dw"d�ld tfht4E— Personally Known OR Produced Identific do .
Type of Identification ,,1111 DE state of Florida Type of Identification pEpNNA GIVENS
,``Sptyv , Notary Public- Produced ,.�"`;'rs`�••, State of Florida
Produced L ° °''- m.Expires Dec 16.2015 ry Public-
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Co mission#EE cy Comm. P
858751
Commission No. ,F q ion#EE
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE- - MANGROVE ry
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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