HomeMy WebLinkAboutBUILDING PERMIT All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ick-Z-g- I S Permit Number:
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:
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PROPOSED IN,POVEMENI'g LOCATION„ ..=_
Address:
Legal Description: 4_1'r-mon5c hi'A4%k kal(c>✓1 5\A7r�lLA"5/6 k2
Property Tax ID#: 3/-76l-DL 3y-CZ,0/9 Lot No. '2_1Izz
Site Plan Name: Qp ch,e D, Block No.
Project Name: u'J� Ce e-
Setbacks Front Back:(�Right Side: Left Side:
DETAILED DEGRIPTION OF WORK ... ,. �.., �_
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CONSTRUCTI4NIN>=ORMTION� "
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Additional work to,be performed underd this permit-check hall that appy
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _ZRoof
Total Sq. Ft of Construction: I AC0 Sq. Ft.of First Floor:. IZ07
Cost of Construction: $ 2,1C7D° Utilities: _Sewer JSeptic Building Height:
OWNER/LESSEE �� CONTRA ;"1 1 �� ,r� 4
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Name e_ `e doe 'r � Name:
Address: `k sk Company
City: Pima x State: Address:
Zip Code: 3`J7Y(,o Fax: City: Vey Stater
Phone No. 772- Cn/t-3a2_9 Zip Code: Fax:
E-Mail: Phone N -6/8`
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State7r License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRaUGTION LIEN LAW"'INFORMATION
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:g _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 nomork 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.
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Sig ature o wner/Lessee/Agent Signature of Contractor/License Holder
' STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � �1� - COUNTY OF
The forgoing instrumeakwaA acknowledgqd me The forgoing instrument was acknowledged before me
this ay of 20 y this day of 20_ by
(Name of per c nowledging) (Name of person acknowledging)
(Signature of NotaQ Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Kn• t' c io ? Personally Known OR Produced Identification
Type of Iden iia ' "''• / GLA iN HUFF t Type of Identification
Produced =_� �= mWtar u tate qt Fiorlda Produced
+ + 0mmissi0q N FF 234730
M Comm.Expires 2019 Commission No. (Seal)
Commission Y p y;
ough'rmiona!NotaryAssn.
REVIEWS FRONT ZONING, SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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