HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F!34982 i
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED INP.ROVE T LOCA=TIC��4
Address: • AJA UAi+
Legal Description: Ql^[�Qe,A T)eaah %b-P az I �- .unti ��f
Property Tax ID#: 1441'5- `70 J`CMY—lJl lJr`"1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTI;OIV Qf WORK
41E C . I K-e r Ii Ve Walw ssouree e&-l- t0 F
.:u.�.. Fs. ..�.
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:CONSTRUCTION tNFQRMATfON
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Additional work toe. e orme under this permit-check a apply:
❑HVAC E]Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Q Roof
Total Sq.Ft of Construction: Sq.
S .Ft.of First Floor:
Cost of Construction:$ �C�FJ�J Utilities: Sewer Septic Building Height:
OWNER%LESSEE : CONTRA;CX�R^
Name Name: uhf U
Address: # SO Company: 0—c Iraisure a Sfi
City: �' l�C� State: Address: W U2,
Zip Code: 8qAkAQ Fax: City: State:
Phone No. Zip Code: S2- Fax: 77a-t1'&!5 l
E-Mail: Phone No. 5_—/!006
Fill in fee simple Title Holder on next page(if different E-Mail:QCf gah?ee,OPeJY� 6 (?l���Ma_i/. (1&(—
from the Owner Listed above) Stat r County License: V
n C�: : 85Y7
If value of construction is$2500 or more,a RECORDED Notice of CommencemiKnt is required.
.SUPPLEMENTAL CONSTRUCTION.LIEN LAW 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.
wature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORI A d STATE OF FLORI `
COUNTY OF l� LCtCle� COUNTY( �af"i ( ClCfe�
The fo� ing'snstr ment was acknowledged before me The far�oing instr�tJ�#�nent was acknowledged before me
this� day of7� ,20-M by this day of tiuly, ' 20®by
(Name of person acknowledging) (Name of person acknowledging)
� 11111111f1 �''���i Nllilllll
(Signature of Notary z, — EP Ff (signature of Nota ub' -Statioffln�a J•�4 <<y
Personally Known = ": Produ�gec� »cation Personally Known Ol�r��' r44�ntlfic�t�1��_
Type of Identificatio l d o^ b�:Q= *Type of Identification Producd_u,:y a s �•u-�_
6dv ar ¢a:`q` �Z I op aLu
1 ,2 Commission No. •.•••• ;:� �1) Commission No. %
NOTNAI
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED