HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numberj SDC, 05D_�
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 41
PERMIT APPLICATION FOR:
Address: V 7111JV l /�/ J��� �✓/��'�
Legal Description: 140T 7`�.���N/f.� C-di4
Property Tax ID#: ya a O 0 Cj Lot No. 3
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:
sT e4C_7- L4_G1'9q,Dk'r afQ r--;l c�i�-vim
Witionalor to be perrormeci un er t is permit-check all tat 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:$ (nib • O U Utilities: —Sewer _Septic Building Height:
Name �) u t�✓'a-�El �� �r,..��� ���k 1,E.C. Name:; }�' U
Address: S 1J olel '� Company: i ,oiti ?�" /d.Cll�' C
City: ""State: L. Address:p — 3 _ST
Zip Code: ";Y qcl (� Fax: - City: Ad;4 2 State:��(•
_ T
Phone No. S f-' Go`i-S - 2-�(0 Zip Code:/9�'D Fax:
E-Mail: Phone No �:2a- '7 (�
Fill in fee simple Title Holder on next page(if different E-Mail C,6,yrW�Ait,lrS AA C_11�3
from the Owner listed above) State or County License ��C /5-16,80 ,3-
if
5`16,80 ,3-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 ofthe 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 of Owner/Lessee/Agent Signature of Contractor'/;LLiicense Holder
• r
STATE OF FLORIDA ti STATE OF FLORIDA
COUNTY OF ,� � CCOUNTY OF
The qng instr ent s -cknowledged fore me . . The for oing instru ent was acknowledged-before me
this ay.of 20y this of 20 by
(Name of person ac nowt dging) (Name of person acknowledging)
Liu
(Signature of No a Public-State of Florida kSignature of of ry Pub is-State of Florida)
Personally nQ �if ation Personally Known OR Produced Identification.
Type of Id a NGELA M HUFF Type of
yp ary Public-,State of Florida
Produced = •• Produce_
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My Comm:Expires Ma 34730 .+ .��' Notary Public State of��((��QQ�r�)
Commiss Bonded,lh NationaiN�y s 9 Commis t •• �FF 234 3
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ary Assn. •, off i,oP.• My Comm.,Expires May 27,2019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION'. SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014