HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO USTJPE COMPLETED FOR APPLICATION TO BE ACCEPTED �I
Date: Permit Number:
� - 4.t RECEIVED AUG 2 81015
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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: �v
PRCPQSED INPRCIUENIENT LOCATIpN
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Address: 014 01rO)Ii)&
Legal Description:
Property Tax I D#: 00 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
PET,AILED.DESCRIPTION OF WORK
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TRUCTION INFORMATION
Additional work to beperformed 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:
CC
Cost of Construction: $ � �J.• 00 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE = CONTRACTOR:
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. �a _.. .. ,
Name 6o/YC(,-, &6Le h 4 GD W AeaZ2..q,- Name:
Address: 7/W 0/: Company: z'q_Gk.
City: 1-ack State: FL Address: I1�7I sd,j •er'�oc�
Zip Code: 3 '�� Fax: City: State:
Phone No. �3 �- /�/�7 Zip Code: 3!J0iS3 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page (if different E-Mail: 1)G2 Com''6z i�0�A�l
from the Owner listed above) State or County License:�(0-2i4
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEIVIENTAL CONSTRUCTIQN 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
commerrcNg work or recording our Notice of Comm encemen .
SignaturSTATE=RIDJW
Agent/Lessee Signature �Co)nra ctor/License Holder
11
COUNTY OF Ja_
��J COUNTY OF STATE ORIDA 4��j
The forgoing instrum n�t was ackn wledged b4ore me The forgoing instrum nt was acl nowledge J).efore me
this day of 20 by this day of. 20,&_ by
C Q 11.x` j Zi4 CLAUDETTE D.PA YEN�� zOa do
(Name of person acknowledging) PUBHO (Name of person acknowledging) GLAUDETTE .PA N
STATE OF FLORI A NOTARY PUBLIC
Comm#FF194477 _STATE OF FLORID
tQa Explres1/31/201 , :Comm#FF194477
01
(Sig ature of Notary Public-State of FI ida ) (Sign ture of Notary Public-StatE6ff Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal) -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014