HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��fel—15
Permit Number:.
-+�
- - 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 V
PERMIT APPLICATION FOR:
11111100001 lNPROUEME LOCATION:
Address: 32p � �7 y�e� r �°��vC�, / Lei 5-2—
Legal
ZLegal Description:
Property Tax ID#: '2- ED — '<M / 1" d 041 —ono d Lot No.
Site Plan Name: (tiJ idl,/SJyy 114,4j l V i' t L Z-1 PT,vg% Block No.
Project Name: 0
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CO STR�UCTIC♦N IiNFORMATlON:.
Additional work to be performed under this permit-Check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
l,lectric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ OW Utilities: —Sewer _Septic Building Height:
OW4NER/LESSEE: CONTRACTOR:
Name _ - ,Name:
Address:1. 70 r any: la L S-Ir;
City: State:e Q Address:
Zip Code: A Fax: City: State:
Phone No. Zip Code: 3 ctf IV_2 Fax:
E-Mail: Phone No 7
LL �-� 6 t F/
Fill in fee simple Title Holder on next page (if different E-Mail &g7&es L. Q I-ecy-i C Q a6 (. e O►'kx
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required. C�
SUPPLEMENT L CO130 11;NJNJIEN LAW INFORMATIQN:
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 our Notice of Commencement.
Signature oi(Ovin ssee/Agent Signature of C tr to is se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,, COUNTY OF C J
The for oing inst .merl w s acknowledged�efore me The forgoing inst ent as acknowledged before me
this day of 20�y this U day of 20r—) by
A co
(Name of p son ac . wledging) ( (Name of persor�a�knowl dging)
(Signature of Notary Publi -State of Florida ) / (Signature of NotaryPublic-State of Florida) /
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification `
Type of Identific�at' n I Type of Identifi ation
Produced = Produced
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DAM:v1tlONE
yr "�� Not r Public,-State of F "i 1a
Commission No. ;_• My R pries V it 22,201 r ,Commission No. ;otT h -,- ,-C�a11 AWN MILONE .
Commission# eF 617571 ; _� nro ►Y Public-State of F!,r; a
"T o; Nacional Notary Assn. vajv My Comm.Expires Mar 22,2 1
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DATE
RECEIVED
DATE
COMPLETED
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