HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED \
Date: \\ a3 5 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:_�EG94tZD 4�_-,4,56-5 S
PROPOSED fNPRC>VEMENT LOCAI"ION „ a h • _ „`,
Address: c i L V?�?2- T ;i' Z./ �' i L P
Legal Description: 3 35 y(p6 5 0 f 7` p/m fjJ.T 6 6 r- 0 J
-7'b fZy5Soa r 1'�r�- v N , 10 , ., C2� . J�kic,�lr�r I 1,6 -� a ?2)
Property Tax ID#: '� --�.�a —000 - Cobh�® Lot No. �S
Site Plan Name: Xr C-4 -7 Block No.
Project Name: G19 SSS � �
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK �
4
CONSTRUCTIQN• INFORM ATfON:
�p ys
Additional work to be performed under 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: $ a'�C3a.,4.b. Utilities: —Sewer —Septic Bu :Height-,
01NNER/LESSEE � CONTRAC
TOR::
.. �•,
Name Name: t,,:� t��5:
Address: 017- S%'Yr►f 'rp, Company: i - G'
City: State:, Address: / P7 4 Ue8i-1 -6�I�1- (.�►
Zip Code: 34 C! Li(--;, Fax: °��1A City: - i� C, 'State: LL,
Phone No. `>' Zip Code:,q/ 1 Fax: ,_)64
E-Mail: + Phone No -7-77- E Ste'" )9 9 �5-
Fill in fee simple Title Holder on next page (if different E-Mail S }�(� f' 0-2_J [J sq 0, `rr 4C1u. Cbl
from the Owner listed above) State or County License L_61 - /2,57'9 —5' -Z—
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: / 3 Name:
Address: Address:
!�
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: .e1 / 7 o-' Address:
City: / City: ° v
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 recprding your Notice of Commencement.
gnatu a of 0w er essee/Agent i nature o ractor/License older
STATE OF RIDA \ �s p �`� STATE F LORIDA
COUNTY �J� \ COLIN OF
The f r oing instrument was acknowledged amore me The forgoing instrument wa acknowledged be e me
this Qo flay of ,20_6by this aNday of 20�y
(Name of person acknowl ging) (Name of erson acknowle ging)
J
e:eo
(Signature of N to y Public- ate of Florida) (Signature of Notary blic-State of Florida)
Persona KS alflfion erg o n OR Produced Identification
Type of �i ' t o ovary Public
,nti isStateof Florida NnlarympqN
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION S,` URTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014