HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•Twp xu^ r g,.:,i�.-� :w Vis,e � 7..e,' �< =
RECEIVED
Building Permit Application OCT 2 2 HE
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: W ccVz4v
PROPOSED iUPiROVEMENT LOCATIC►N .`
Address: 0 7G�buI Jamz!S rcj jioc-4 Piero l-L gQ-61
Legal Description:
Property Tax ID#: 130)- Go 1- woa- n6o -7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF 111/ORK `s
a s;
CONSTRUCTIQU I(VFORMATIO.N A
._
Add itionaI-work to be performed under tis permit-c ec 'a Tat appy:
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: $ it 7qS-O-C) Utilities: —Sewer —Septic Building Height:
01NNEft/LESSEE '` ` `CONTRACTOR '
Name , k p Pcta,r zTk Name:
Address: �- �1a,�t� �c) Company: �10=feek &r,.._ boor
City: qai-� „arcs State:f(- Address: 020- AlW M M"ecAn igi,c)
Zip Code: 4MqqFax: City: Pkx' %uc.,'c Stater
Phone No. w, Zip Code: j306 Fax: 4ft
E-Mail: Phone No .Sq2I
Fill in fee simple Title Holder on next page(if different E-Mail � � hc�tc,/Sar;G_ c� ilatitla a'�
from the Owner listed above) State or County License 4�ilef S'6�
If value of construction is 2500 or more,a RECORDED Notice of Commencement 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. 4" 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.
C�/.�1i�vlJl cam. �.sss�
Signature of Owner/Lessee/ F Signatu�rhe oc'.f tractor/License Holder qL
STATE OF FLORIDA STATE OF FLORID cm
COUNTY OF =_N� COUNTY OF kNv� &6u'
� v 2�cO
The forgg�oing instrument was acknowledged befor r : The forgoing instr ent as acknowledged be 9 Jit
this qday of Q 20 JA by �� this day of 20/��b m
Name of person acknowledging) (Name of person acknowledging)
a1 •4 ,n�. w;,
ox
(Signature of tary Public-State of Floh U (Signature of ary Public-State of Florida)
Personally Known OR Produced Identification / Personally Known OR Produced Identification ✓
Type of Identifi do Type of Identi
ProducedJ /IProduced + I'
Grp
Commission No. (Seal) iw Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
CGONTER REVIEW ',,,REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE tt
COMPLETED
ev. /2014