HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:1509 —DO 17
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:
Address: 9 aLr' A n In k zy- h e
Legal Description:
Property Tax ID#: 3 jg(0 "C6 st—(n6o Iq Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back:J�; Right Side: 7 Left Side: 3
C o�� rad c.►�c� i rl �l YI ,!• /.
Com/ cited �' G CA-L &r
nG>~�Ve d e '� - G7 " n , T-4 1�-- k f' i'n r
c A . .Wr i� -M eS
Additional work to be perrormed 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: Sq. Ft.of First Floor:
Cost of Construction:$ 2 ra U yu Utilities: —Sewer _Septic Building Height:
Name 122 0--g Tr-,- Name: ALL - Adno.?` c-oT joua/�e�s
Address: J C?d 13cvlrA n � �.. n , Company: R e,7-Aa d-ejey-,t;
City: DOT-:7- 57'. State:EG , Address: C2 n �, /.fie r/c�I, +� i?�
Zip Code: Fax: City: Stated e-
Phone No.7 7 2 -;,31 — 441 -9 3 Zip Code:3 17,5-2— Fax:
E-Mail: Phone No 7 7 Z _ 7q - 7S-41 7
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License C Ri co 2 6 2S4
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 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 of Owner see/Agent Signature of ContraMr/License Holder
STATE OF FLORID ;� — STATE OF FLORIDA
COUNTY-OF,, r t ��'� p� COUNTY OF , A
The forgoing instru ent s acknowledged before me The for oing ins umen was acknowledged before me
this day.of 201 by this dsyofo l by
1
(Name of person acknow dging) (Name of person ackn ledging)
(Signature of Notary Public-State of Florida} (Signature of Notary Public---S of Florida}
gip. .
Personally Known OR o �{&� e ����� jyt+MAlte>~dE 'FPerso ally Known OR Produced Identification.,
.. -Flo RY aV q,�
tP a Type f Identiftca �Type of Identification .?o, .r% Notary Public.State of FlA)i qa. DAGVN IV�:_3NE
Produced `•' " • My Comm.Expires Mar 2 Pn91 ced y2o�R-,`��.� o ary u is-State o1 Florida
t;ommission#EE 87 571 << q
,oF�` �` •=M Comm.Exh����r22;2017
Commission No. �,,,+++�°(SeBbaded Through National Not r�fi. ission No. "` y otnmissio 877571
��+ � Bonded Through National Notary Assn.
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