HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOUST B OMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IPermit Number: oO
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 IlJMPROVEMENT LOCATION:
Address: ?-q)0 S C) GAJ Of S/ e,
Legal Description: SAN10 c9J t.0 19(21 yJ X_S L'WO-
Property Tax ID#: 3S012 Goo oaA v UoU; Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Tc PL4 CE. S AN►CC Fvrz- SA^4 a JoN /11c. S cS SE_'r( r vd-4 • 17.S/Ccs) 146A i
!„✓, tiMC/Zt v1,0 5y',✓.dA(Lo a, l q• S R S,-B rc:Fm
CONSTRUCTION INFORMATION:
��
Additional workto e e orme under tispermit—c ec a appy:
[aHVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator E] Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �G00 r Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name �f�V< (22 62 S 3�2[�___�C M f Name: !9C IJA" Q, i/vCl��ln r
Address: eaq l S Viii/N z6p_ f Company: 6UL.4
City: (Y)r_C&J/zN C r1- 2a ,State:-Lt. Address: 6233 . A/Zl f-h)&l 2JQ EN
Zip Code: —3 4 C/f{o Fax: X City: !RRJ-Sr COCA Stater
Phone No. ,�2O0,_? Zip Code: `3 Cl 5 Fax:
E-Mail: Phone No. Aqs :J
Fill in fee simple Title Holder on next page(if different E-Mail: yL L!l 4A_-,r La coli Nom-
from the Owner listed above) State or County License: 1(01 1 S•4• C
C- C v o`t
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
"'. ; E ', ' ,_�... 'm' ,s Wit a oe t". "'
S2UPL�M z. 7kT01�liEl� W R.tVl1T .: �.
a� s � �e° :,::
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.
q,
Signature of` w er Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �� -e- COUNTY OF l
The forgoing instr nt was acknowledged ore me The forgoing instru t was cknowledged b fore me
this '�day of 20 L_�by this day of 20y
(Name of person acknowledging) (Name of person acknowledging)
11:N iN
(Signature of Notary P lic-State of Florida ature of No blic-State of Florida)
Personale d n i is tion ersonally Known R Produced Identi Ption
YRe
Type o ANGELA M HUFF �nav P,.,, ANGELA M HUFF
roduce _: = Notary Rub1lc-State o Florida Prod ceif B.•-
ommisslon#FF 234730 WFY PubliC State 01 a
Commission#FF 234730
��;� My Comm,Expires Ma Comrnissfo. +.` M Cnmm Fvniroe
Commis ori �{j; °. p y 1)Sea)I9 v-�. May 27,2061 I�
` ational Notary Assn. !through National Notary Assr
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.