HomeMy WebLinkAboutBuilding Permit Application ALL-APPUCA13LE INFO MUST BE-COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ord d71 15 Permit Number:
- -
-------------- -------
Planning and Development Services Building Permit Application
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: To Select from dropbox, click here
PRO .6 IN_PRQVEMENT f_OCA`I IQN,
Address: do27 Qj7` ` iM' C.ctYkkS 2-`e
Legal Description: 1/ h 4e- I IA -CEI y J`✓t HO 33/Z
b 1-kogq G� Q 1 J�--
Property Tax ID#:5-321- Ud3-M-I-0bb- C5 Lot No. moi'
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIRTION`OF
I'Me l i hie K, 1U6QA-;a1A)&
1
CONSTRUCTfO.N INfORMATfQN
Additional work toe e orme under tis permit-c ec a appy:
OHVAC 11 Gas Tank F]Gas Piping _Shutters Q Windows/Doors
Electric ElPlumbing Sprinklers 0 Gbnerator D Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
O
Cost of Construction:$_ � Utilities: Sewer Septic Building Height:
OWNEfz/LESSEE CONTRACTOR
Name FlfCLK V, Name:( Ue T /
Address )Ojanfah es bri Company: Ie j S(ofe akFs7`
City: 0t+ ual6 State: Addrif-
�
Zip Code: 'Ma Fax: City: State: -055-
Zip No. �foq- �- �5�(n Zip Code: Y98 Fax:: // �
E-Mail: Phone No. '79-/-6 Jam-/►DUO
Fill in fee simple Title Holder on next page(if different E-Mail: 1/112
from the Owner listed above) S to or County►License: (i,/ L' t73�lol0
beet{
If value of construction is$2500 or more,a RECORDED Notice of Commenc ent is required.
SUPPLEMENTAL CONSTRUCFfON"UEN LAW INFORMATION:
DESiGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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.
�iaa_�ture of Owner/Agent/LesseeSig ature of Contractor/License Holder
STATE OF FLORt A STATE OF FLORI /
COUNTY OF h' Lu�e� COUNTY OF C�gia1 i I&CI&
The omg instru en was acknowled ed'before me The for oinginstrulnentwas acknowledged before me
this_day of 2030 by this day of eJ14 20[ZVby
'
(Name of person acknowledging) (Name of person acknowledging)
� 1111111ff1 /!
(Signature of Notary-0 18�ff F (Signature of Nota744Vid
-Stat a ricga� * !ii
-CS, ��0��fPIREg"'•beyPersonally Known �2 Protiu�c i fication Personally Known rpM%ntific tt _
Type of Identifcato" �d Type of Identification fcation Produc�w•y`ti :u--
_�.� •
Q'• 6�0 Gib Op Jai ti�
Commission No. �'o '�y ems`:'•' �1) Commission No.
Revised 07/15/2014
/////lllll 116{0114\\\
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
r