HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: �5f✓Q'
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 INPROVE;MEIUT LOCATICI=N `3 , a� � � , A
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Address: /3 �Ale,,j C y-'S-�N� CGu,4
Legal Description:
Property Tax ID#: I L)i I L-� _70 0O Sd OC-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE7'AI�:ED OFSCRIPTION OF WORK Ag
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CONSTRUCTION INFORMATION. A
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Additionalwork to be perFo-r—meR under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
t _Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $(15-0(9, Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE # _ x;k x CONI-RACTOR' `�f
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Name �3r'l( �vtis Name: l cJi`1 y' t-S k w
Address: /31 Company:_ C //G
City:¢ e(''-Yrct Stater Address: `SCJ- 2' -2,'-*" ff�ic
Zip Code: Fax: City: (3C-4'f y Stater
Phone No.�77S-A\ 6 19 q!3 Z3 l Zip Code: 3 2-R(o d Fax:
E-Mail: Phone Nk -t-1 Zl 5-0 Z.S-
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.
SUPPLEMENTAL CONSTR-UCTION;LIEN LAW INF-' RMATIQN
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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
commencing work or recording our Notice of Commencement.
ignature o wner/Lessee/Agent Signature Contractor/License Holder
STATE
COUNTY OF FLORIDA 1Q OY OF FLORIDA -�-LTr S
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Qc-� ,20 Irby this 2.1 day of Q C k ,20�6_ by
�r �-
(Name of person c nowledging) (Name of perso acknowledging)
(Sig ature of Notary Public-State of Florida ) (Si ure of Notary Public-Stat of Florida)
Personally Known OR Produced Identification\ Personally Known OR Produced Identification
Type of Identification -- Type of Identificati
ProducedProduced Ry
EASIAHNAINGRAM NA!
u.;•, ,• +�: Notary !i NGRAM
Notary Public-State of Flory::
Commission No. 5 • l._ y Comm($ s11�s Dec 20. Commission No. ' ,,� �:P CommubX S a of
Florida
Commission # FF 177. „.FLoa°.' Pires Dec
V „ ���„ 8n �ommr"on#F 20.2018
'SOF F�V.• wriKIM" A I;�, •.:.� _ F izz
-�4 anon I Nota'v
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014