HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE NFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: j t Permit Number: < 1 I
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPRC►VEMENT LOCA-f ON:
Address: - a / / ��lt./✓N�t. LA gezcto �� 35� Fy6
Legal Description: 7, 6/oC/,c
(.�_26 / ,
Property Tax ID#: /�7 O ��1 7 U z - 00 Li- - o oo - 7 Lot No. ,3
Site Plan Name: L'?_a F Block No. 2--
Project Name:
Setbacks Front Back: Right Side:��Left Side:
DETAILED'DESCRIPTIONDF 1_/ORK. `:
SCvae,L A ?2c LCA' 2-
423
CONSTRUCTION INFORMA
FORMATION'-
Additionalrtiona work to'be er orme under this permit-check.a app y:
HVAC E] Gas Tank OGas Piping _Shutters ❑Windows/Doors
0 Electric 0 Plumbing ❑Sprinklers 0 Generator 0 Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ (�o c+ Utilities:]Sewer Septic Building Height:
OWN;ERAESSEE._ CONTRACTOR:
Name / c,/A'zy Z" Name: ��. ,
Address: S Z(o �� �G,/W,-/14 Z I,/ ,- Company: !L-19 Do���s ' 23 wil e1refz5
City: State: . Address:Zip Code: Fax: ✓h City: t'oye �����' State: /—,Z
Phone No. rF/, t� Zip Code: 3�16-311 Fax: ►�
z E-Mail: Phone No. ILL 3-72-
A 'J
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: /:1,3�-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
20,
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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 confflict 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. 4
r�ATE
ature wn essee/Agent S' re of Contra License Holder
OF F IDAc � L �k_z c4t��
UNTY O _ �l LkC� COUNTY OF
The going instrun t a a knowledg ore me The forgoing instrument�was�a knowledg a me
this ay of 20 by this�day of---�� 20 by
(Name of person ac nowle ging (Name of person acknowledging)
G"A ("L, Y�
(Signature of Notary blic-State of Florida) (Signature o otary Public-State of lorida)
P' so , no d ced Identification argon O Produced Identification
T � fi o Puh EeLA M HUFF T PANGIAMFF
State of Produ •� .�+�- NotarUFFC U,Florida
MY Com oq FF234730 c� 'P C.om2347of��q;. m.Expires Ma ” P•o c MY Com �¢N9or�hiel Y27,2019 eal) Comm siE o,..•• y 27,tilFVdIlo°a �a►YAssn. °ndWotthary Assn.REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIONRTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE .
COMPLETED
ev.