HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO NJUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED D
Date: 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
PERMIT APPLICATION FOR:
PROPOSED lNIPROUEMENT LOCATIQN;
Address:_-7-5-0-7 5At14-A I✓' IAEA ✓ LA lc(+ Ior(P FL, 3g95- 1
Legal Description:
Property Tax ID#: �� 1 L Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:
D�ETAILfD DE��CRI`PTION OF WORK:
o W, i A S bed d,f,LAlicharU !e C°
Ce NSTRUCT(J=01;
Additional wor 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: 1 a e `�, Sq. Ft.of First Floor:
Cost of Construction: $ 'Jq Utilities: —Sewer _Septic Building Height-
®WNER/ILE�SSEE: CONTRA(:T®R:
Name 11n�Chi.eI v a ?z4 Named
Address: 75-t-)-7-$ 4 C 0i1 rill• ComplAny: ^e 1101'4
City: F-j State: L Add res
Zip Code: :3 q9-';'f Fax: -77A- '&-I-1 0 City: State:
PhoneNo. a ✓�S�S�Uy L'�II77� 9/�� Zip Code: Fax:
E-Mail:broacin 3"7y0(9 a 01. Cpp y7l Phone No
Fill in fee si W ple Title Holder on next page(if different E-Mail
from the Owner listed above) State orC unty License
If value of construction is 2500 or more,a RECORDED Notice of Commen ment is required.
SUPPLEMENTAL CONSTRl1CTI0N L EN LAW INFOR++MATIQN:
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 O er/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA ZSTATE OF FLORIDA
COUNTY OF _�_�[`�� COUNTY OF
The forgoing instrurrAnt was acknowledged b fore me The forgoing instrument was acknowledged before me
this �- day of 20n by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notb3y Public-State oFlorida) (Signature of Notary Public-State of Florida)
Personally Kno n OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identifi tio(,� Type of Identification
Produced ANGELA M IjUFF Produced
* ,,- ary Public t State of Florida
Comm183i0hM(MR34730 )
Commission NAli, Commission No. Seal
i,OF Flo mm.Expires May 27,pot g
Bonded through National Not
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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