HomeMy WebLinkAboutBuilding Permit Application All APPLICABV INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�/� � /S� Permit Number:
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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 Residential
PERMIT APPLICATION FOR: C
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PROPOSED INPROVEMENT LOCATION
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Address: 6 a.6 ��o AGS
Legal Description:
Property Tax ID#: `V Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR1PTalON C►F WORK
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CONSTRUCTION INFORMAddATION
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itio wor to be pertormed uncier this.permit-check all that 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: $ Yl Zs-o Utilities: Sewer _Septic Building Height:
`OWNER
/LESSEE 3� R 3 CONTRACCI ; k� a
Name c� _�'x -� ��1ke_'-'6_C, Name: S ` - f
Address �f.. r�� _ Company:. G f':d l 4i� Co S
City: p e/le-e. State Address: c�Yb
Zip Code: ' q Fax: City: verb State: G
Phone No. � 7 Zip Code: —7'0,9G Fax:
E-Mail: Phone No 7 7 z-7r3— -2-24
Fill in fee simple Title Holder on next page(if different E-Mail af' cs ZC/- 7@4�d o•cdAi
from the Owner listed above) State or County License 7 �
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if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN X,,V 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
commencing work or recording our Notice of Commencement.
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a ure of Owner/Lessee/Agent n ure of Contractor/License Holder
STATE OF FLORIDA � ' — STATE OF FLORIDA
COUNTY OF �� �1�--I� COUNTY OF U�
The r g instru t was acknowledged re me The forgoing instrument wa acknowledged ore me
this ay of 20y this�ay of 20�by
(Name of person acknowl dg' (Name of person acknowledging)
(Signature of Nota Public-State of Florida I I ((Signature of Notaryublic-State of Florida)
Personally K an c i LZ Personally Known OR Produced Identification
Type of Iden f� •`• — �ANG,ELA M HUFF Type of 108P A
Notary�Pu ff is-State of Florida '•"`"`�
Produced Produce
1u, Z mss on FF 234730 ;r. ; Notary Pu Ilc_ HUFF
a My Comm.Expires fojj�2019 Commi • • C ¢ State of Flda
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Commission o: Q , �.
n gh National Notary Assn. "%,9F F�oP°� MY Comm, FF 234730
Expires May 27,Idl 2019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURIL MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014