HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUU,ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /1
Date:O �� J/,> Permit Number: (
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
12300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential r/
PERMIT APPLICATION FOR:
PR®POSEATtl N;
Address: 82 Yo f/�a,ae� �'/�,/rs3 /i �P/excC ic-L 3 yyy.r
Legal Description: 14/0,0&aJ ®-,N&-S A371fT 3 &IC 4 ie-r3 ("4
Property Tax ID#: 2323 -7a l o oa 3 - 00 Lot No.
Site Plan Name: Block No.
Project Name: 1/A ewl Qt
Setbacks Front Back: Right Side: Left Side:
OETAILE® DE�SCR+IPTION OF 1I1/ORK:
9C�fov� Set-4 �/IyE�L s/oCly/1L/G //J �j c?'L�Oec' w of iiAc7Z icfFS/l CCA-7
/ffC/C - .3,000 P-5/. 11J.s-QLL Z•Xy�` 4l ACiYo.31 w/1rp914).5 MIo fv/yRL
C®'NSIM R CTI®N INFORMATION:
Additional work to be pertormed under this permit-checR all that appy.
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
t � �
Total Sq. Ft of Construction:< .� Sq. Ft.of First Floor:
Cost of Construction: $ (oo.a o Utilities: —Sewer _Septic Building Height:
®1NNER�EaEaS�S'EE: CONTRA 'I"0!R:
Na me 4VVI5 4-,4,vN 11.10/4' C#I--3tiuT Name:
Address: f?2 510 /oi4/4-s /'i D Company:
City: /-,T 40cC State: 1.57 C Address:
Zip Code:3y 1 y-} Fax: NA City: State:
Phone No. 7 7 z z o/ 169-5-6' Zip Code: Fax:
E-Mail: PeWAI-sC#c-svuT 0 6,0l •COA1 Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJ��PLEMENTAI.CONSTRUCTION LI+EN LAW I FORMAI"ION:
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
comm"cing work or re4ording your Notice of Commencement.
Signature of`awner/-Lessee/Agent—`— Signature of Contractor/License Holder
STATE OF FLORI - STATE OF FLORIDA
COUNTY O COUNTY OF
Theor oing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20_ by
(Name of person acknowledging) ` (Name of person acknowledging)
1
(Signature of Notary Public-State ot Florida) (Signature of Notary Public-State of Florida)
Personally Knownd OR ProI n 'fi
ce cation Personally Known OR Produced Identification
Type 8f 1* .ions' Type of Identification
DAWN MILONE Produced
RZ Nly Comm". Xpires Mar22DAWM';i,.' w:
Com s$i a C rtmi ` �a?VF�ealjl,te ., Florida Commission No. (Seal)
0o11Bandkd 2O •_i�pQaCtloir3ry,f,°,r r': ,ar 22,2017I
is i i E 87771
•,
Bonded � !dotar
Assn.
REVIEWS FRO NG SEI
R PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014