HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO�IJST BE COMPLETED.FOR APPLICATION TO BE ACCEPTEDDate: ' Permit Number.
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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:
PR o OSED INrPROUEME 'T LO.CATIO
Address: dtan= A ye-
Legal Description:
Property Tax ID#: ,�,317�����– ��0/� ��0� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRIPTIO.N paF W0 K:
044 '04
go/a. 902U.91C i iGe e
Ora 14.7 ve
�ONSTRUCTIQN INFORMATION:
Additional work to be performed 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:$ ��0®_ ' Utilities: —Sewer _Septic Building Height:
NER/LESSEE: CONTRACT®R:
Name 41AV'
4 c co Name: Je7 tio�nn5an
Address: /-110.40 �✓4Nq a Company:A)/ Acre �eelr;c- C�on7!/Gc�o/S �vI`
City: �yr7� 101'4','C' State: Address:f&G a -57'-
Zip
Zip Code: Fax: City: State: J L
Phone No.y�,���"�fO�f Zip Code: t' Fax:
E-Mail: Phone No �7a�,�J 7�
Fill in fee simple Title Holder on next page (if different E-Mail q/�' l4sei f DO.CO
from the Owner listed above) State or County License FCOOK?W—
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Man'STREICI'tON LIEN LAUV IN FORMATION:
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
commencingwork or recordin our Notice of Commencement.
,U7
Signat e of Own /Lessee/Agent-. SidXatuje of Contractor/Lic nse Holder
STATE OF FLORID STATE OF FLORIDA /
COUNTY OFCOUNTY OF
The forgoing ins me was acknowledged fore me The fc_ oing inst en was acknowledge efore me
thisazday of 0 201�y this,� day of 20�y
Qa�� LA- — — AO
(N m of p r n acrowledging) (Name of er n ackno dging)
(Signature of Notary Public- ate of Florida) (Signature of Notary Pu is-...State of Florida')
a
Personally Known A O P d c I e ifi t' n Personally Known , *� r,Qdpced Iden��ftKNtryN€
Type of Identificatiori DAWN MILONE Type of Identification _:; '`otary public State of Flcr;
�.tiPav nye., :m r NA Comm. Cc
Produced ublic-State of F�orida Produced 9 Expires Na•P2
�Q,OF F..... missioo- 2017',
_•, d • My Comm.Expires Mar 22,2017 ..........
��"' Bonded EE 877571
'N�' • Pr ) National Notary Assn.f
Commission No. ;,4:,. Com �S�@p #EE 8.77571 Commission No.
" Bonded?hr)ugh Nalional Notary.Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Re—v-.