HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t O� ��� Permit Number: �SI ` 0000-
4 04
Building PermitApplication
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: To Select from dropbox, click here
PROPOSEDINPROVEM1 IENT'.LO_CATION: .
Address: Z�l
L�d1 `C 11 II --1 L
Legal Description: Y 0 0 C ( M 014
Property Tax ID#: 145-1 - ?Sc)j-0162,- Obb-LD Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED.DESCRIPTION OF.WORK: -
C n o0
4-Too, 40; i
CONSTRUCTION-INFORMATION
Adclitionalworl(Toberiertormedunder this permit-c ec a appy:
HVAC LJ Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric Plumbing O Sprinklers ElGenerator O Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
J-�-/� 1,b�
Cost of Construction:$ 120Y`' Utilities: _Sewer Septic Building Height:
OWNER/LES$EE: CONTRACTOR...:. -
Name Name: MY6d_-*)arhank OP
Address: 9Qnl i. Company: (f
City; Stater Address: -I
Mew
Zip Code:J Fax: City: -� r tState `
Phone No.1`J2—Z4Z— 9A1`1 Zip Code:34'1'9 - Fax.r71 `t' 6 �q T�
E-Mail: Phone No. rS
Fill in fee simple Title Holder on next page(if different E-Mail: •COP(-
from the Owner listed above) to o Copn y License- ("A0 4 a�
If value of construction is$2500 or more,a RECORDED Notice of Commence ent 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: 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.
G%vr�'u`a'� ,�,c.LiK � nacsr'�� fHli�-sem
i ature of Owner/Agent/Lessee 1f§Wature of Contractor/License Holder
STATE OF FLORIDA( STATE OF FLORII�'A
COUNTY OF )C�i/i� CC(CfP—� COUNTY 01 �llf_fy
The for ing instr e t as acknowled ed before me The for in instr a�t yl�s�acknowled ed b fore me
thisay of 20by this of 20�y
filve T.
(Name of person acknowledging) (Name of person acknowledging)
_ �UIIiIIUI ��rrrr, {lltlltfll
(Signature of Notary - F�i1r ( ignature of Nota ub ic-Stat D riicja) k bre,
.O ,tips m o Q0PIREb' eO�G�i
Personally Known = ,ProRluification Personally Known ' 0R {��' �4i'�ntificY� i%5_
Type of Identificatiio _d i S' ��:Q Type of Identification Produce W
Commission No. e '�� �;: I) Commission No. 6:;" ( ;=�
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Revised 07/15/2014 rrr�rrialtRti{!{i����
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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