HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: y r' Permit Number: �5'�Q• t rt 2
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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 Residentialy
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED lNPRQVEMEN `LOC/�T10,N
Address: Q/i Ili //--0,,,,
e,
Legal Description: Onl,s (
PropertyTax ID#: 1301- //I - CDD/ - coo- , Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRCP710N OF UUORK
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CQN5TftUCTION INFORIV�ATION� L `_ � t ' '"K
Additional wor toe e orme under this permit-c ec all appy:
❑ m
HVAC -Gas Tank ❑Gas Pi in _ Windows/Doors
p g Shutters El
Electric F]Plumbing ❑Sprinklers ❑Generator Roof
Total Sq. Ft of Construction: SQ.Ft.of First Floor:
0f7
Cost of Construction:$ %57C Utilities: _Sewer F]Septic Building Height:
OWNER E,ESSEE 4 COa1t `RACTf{aR :
Name 4.0 C Q/lt Name. n lVe-I !U'
Address: Fe_ Company:ldilonhg=Yqd 61�_fhra2S��
city: nrIerPf� State:EL Address: D(
Zip Code: c3g95t Fax: City: State:
Phone No.M.) Llo(v-'&3 5S Zip Code:l5yg8 Fax:
E-Mail: Phone No. 712-11&,! Aolo
Fill in fee simple Title Holder on next page[if different E-Mail:Q $I' `� CQ
from the Owner listed above) State a ounty J :
MO.. egg 7
If value of construction is$2500 or more,a RECORDED Notice of Commencement i equired.
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 thepermit 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
commencingwork or recording your Notice of Commencement.
ature of Owner/Agent/Lessee �Svature of Contractor/License Holder
STATE OF FLORI A STATE OF FLORt `
COUNTY OF (f� Cle� COUNTY OF � Oc[vt t" ICP"
The for ping instr ent as cknowled ed before me The for Ing instr ent as acknowledged before me
1 :9 day o .2011 by tnMele._
for
of P.1' 20MTby
6611nuel T. u�> � 7r y
(Name of person acknowledging) (Name of person acknowledging)
H11111111 /// 1111111f11
(Signature of Notary
SF Or r ( ignature of Nota ub' State r�qqj.�k Zl*
0 2 0. PIRES
Personally Known W t�Prp Ad—A ification Personally Known !!!/�� Oi f4l'd ¢4 ntiftc S1 `G�_
Type of Identificatiot d Type of Identification Producacu:=' •
Commission No. % •-Y Commission No. s •u" ( i :��
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11 TA"11�N
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED