HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 +3~ Permit Number:
-- 1 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:
PIR UPOSIR11N' ROUEMENT LOCATI4 :n
Address: -1 cJ e4J(� ce(1C-P_ EL, i S
Legal Description:
Property Tax ID#: Lot No.
Orin Site Plan Name: S Ori �fi k ���-e C & (V mites S Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA!LED D.E�SCRItPTION OF WORK:
er4S (Wl Cc,tt CIAirl 4 c�
2�
06j 601 0008 111FORIUTATION:
Additional work to be performed under this permit-check all that
Mechanical GasTank Gas Piping Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: , } Sq. Ft.of First Floor: u
Cost of Construction:$ l l7 / Utilities: —Sewer —Septic Building Height:
OWNER/LE��S��E: CO�_��NTRACT'OR:
Name Name: Cc.t/
Address: V L(tee, Company: 14, Com✓ V6
City: N \ G State:_ Address: 16 03 1Pe
Zip Code: CT 5— Fax: AJA City: -e' c-e- State:_r__G 1
Phone No. - Jam/ S 5 Zip Code: � � Fax:_2
E-Mail: W AJt'/q-, Phone No :
Fill in fee simple Title older on next page(if different E-Mail K \/\, V (~
from the Owner listed above) State or County icense ( n J 1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENT &T"R, LN LAW I FQRMATIQN:
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 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, cons t with lender or an attorney before
comrUeMing work or recording our Notice of Commenceme
Signature of Owner/Lessee gent Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF C��it�P COUNTY OF ,
The for oing instr en was acknowledged before me The forgoing instr ent was acknowledged a me
this day of 20�by ftr&� flay of by
n � _
M, `
i- �
me of person acknowledging) ( acknowledging)
ne
(Signature of Notary Publi t to of Florida) (Signature of Notary Public-S kbe of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. ���r' (Q@��MILONE Commission No i�"�= DA
u 4 Notary PPublic State of F`orida "9,. arc MY Cotary public..St.
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My Comm.Expires Mar.22,2017 3 %�FF�o mm.EX it ., te of Fl°�
mission EE 877571 B ndeof Ssion#EE. L4A
0ijREVIEWS COUNTER REVIEW ughNh R � ® REVIEW NS VREVIEWON w REVI IQTalb iMotk IEWVE
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014