HomeMy WebLinkAboutBuilding Permit Application All APPLICAA}B E INF4 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDf`i ��11
Date: V u' Permit Number: 15�1J• c _
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:
PROPOSED !N V'
ENT LOCATIQN
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Address: (n'J®0 ocALA A\�
Legal Description: 12,01 0 3.so 000!q: LA -1/llaD .0
Property Tax ID#: l 3b ( Ji�� d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CF Wow EgZL* WJ�JM
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CO�NSTRIlCTION INFORMfAT�ON �' �
Add
itiona wor to a pe orme under t is permit-check a that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWIV�R/LESSEEEll,
Name .Name:
/-
Address: Company: ptf 'm W
City: C Stater' Address: SVJ
Zip Code: r 6( Fax: City: State:El
Phone No. 7 la+9 _b3CtO Zip Code: 311016-13 Fax:
E-Mail: Phone No `lam a a0 l IL40
Fill in fee simple Title Holder on next page(if different E-Mail L:�nMDMs630!� 6 , f CCIYA
from the Owner listed above) State or County License n`7 L414"1
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN 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 inspectio . If u intend to obtain financing, consult with lender o an at orney before
co encin work or re o d n our Notice of Commenceme t.
1
Sidhature of Owner/Lessee/Agent Sign ture of Cont c or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF !I, 1u� �; COUNTY OF t-"l.�
The forgoing instrument was acknowledged before me The forgoing instr ent was acknowledged before me
thi L day of QJ ,20 /�by thisl_day of Ci 20 fS by
Oil
K
(Name of person acknowledging) (Na f person acknowledging)
A01" L
ignature of Notary Public- tate of Florida) gnature of Notary Public-Sta of Florida )
Personally Known OR Produced Identification ,Personally Known OR Produc ntifi tion
Type of Identification Type of ProduceIdentification NGe -46
o�FA0�20%
Produced o
e
Commission No. e�l,$NpN skakc°2p,2� - mmission o oLr=SEX. s4`'(Seal) '
N�arJP° ores E \1�2A � � '��P \`� ;phiSV
REVIEWS FRONT •:Zf3N1'[pG -S PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTERS ^ . IFWfe�, '" REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.