HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I � 05o
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 l/
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED IN.PROUfMENT LOCATION
Address: s® id6r
Legal Description:�ht�_ pQ,3�Sto t t&445 Over P1 ac9�dn Unree)uA bW' Eiia►nvu)WE vu+lof 22
fUt1 5�4 j 35 tA;n sp Svc 4 24-T4 10 o I a 1PZ r,i 42 50C 0 I-tto 16 FT,T1+til Si be 3Ia
S in SCoSa ...
Property Tax ID#: `3403-�2- 0081 -a00-�0 Lot No. L14-57
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
,'DETAILED.pESCRIPTION OF WQRK.
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CONSTR.U: `ffON INFORMATION
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Additional work to (epe orme - un er this permit—c ec a appy:
HVAC LJ Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
0 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �, � Utilities: Sewer 0Septic. Building Height:
OWNER/LESSEE O�VTR�ICT
C
OR
Name "YC' l lli n Name: u6l -T. ►'
Address:4b5D Qiv Company: 11A ejq C 9 4he-�eo'sw°NS4
City: Ita-e_ State: - Address: (00 Q—t4W RUVWC
Zip Code: 3m2 Fax: City: G + le2-C, State:-FL
Phone No. C tQ- 62n 1510 Zip Code• .gCM92- F/a-x
E-Mail: Phone No. 77o2-! l(0 s��(0o
Fill in fee simple Title Holder on next page(if different E-Mail: ad Vil/?7�tgP.Germ tfs(a2 hOlmai &n
from the Owner listed above) State or County License:C `tom
(.kt.4'
If value of construction is$2500 or more,a RECORDED Notice of I ammencerWnt is required.
SUPPLEMENTAL CONSTRUCTION LIEN 1AW INFORMATION:
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.
Viature of Owner/Agent
/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA�\�'� ` STATE OF FLORI Let COUNTY OF tf ��Ltl'� COUNTY OF kf"P � L et
The forgoing instr}�{{ment was acknowled ed before me The fo oing instr)i�mment was acknowledged before me
this T3 day of tlU�(,t + ,20JU by this /��iay of fly .20Mby
6 f�?vel _7711 ll��t4 Qfnr�ef */`!
(Name of person acknowledging) (Name of person acknowledging)
111111111J1 Jr��if` 1111111fJ!
{Signature of Notary�� r � F bf { ignature of Nota ub. -Stat�� r:�aJ.
� �Qom,•�y,PIRE3 ••b0ib�
Personally Known ` 4 Prot) c t cation Personally Known !ll��� OR '��'d c�4 ntific'
Type of ldentificatio s :oil i�,�a Type of Identification Prod s o� b•��
Commission No. �' � �; �I) Commission No.
NOTP(���\��o
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED