HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 f
Date: 10--- tl�Q �� Permit Number: !�f cp- C)c (0-C
- EGEOVED
Building Permit ApplicatiorPEC 16 2015
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:
a .
PROPOSED IMPROVEMENT LOCATIQN` k
Address: aSI 2 C46)vJefF
Legal Description: W IC-S (?�- 'a L)PA- Q-06 -
-���-3 LC-)T -19C
Lot No.—�
Site Plan Name: Block No. �3
Project Name: F-JA-V"Y+ CE;a
Setbacks Front Back: Right Side: Left Side:
DETiI[ED DL�SG 11?TIOi9FWC+RK
COIF4,61
$TRtCTlOI\1I1�FORMATI ?N �� j _ ; 'a ��� �_ R��
a
Additional'work to a pe Orme un er t is permit check a I I that at appy:
Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
ectric` _Plumbing _Sprinklers Generator _Roof
Total Sq:-Ft-of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ l�D� 0 Utilities: —Sewer —Septic Building Height:
0111fNER/I_ESSE�. xNCON`f-RACTOYR k .1
4_.,.. ._° ., .
Name Name:
Address: �� (2- ( GDU � Company:,,-7Z S ST - C%�dC
City: 29-- S �'h/o
"F• LOCI State: 'L- • Address: �� vG L
Zip Code: 3 2 Fax: -7 City: /!2 ' /1�c�� State:,Y.
Phone No. I•I 2 Z�2 ! 2� Zip Code: �Jz �� Fax:
E-Mail: Phone No2 ^ Z 3 •":1-G-3
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or ounty License Al-t-1-30
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5UPPL�M.ENTAL COIVSTRL1CTlON`LIEN LAW INI ORMATION' '
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, Fdo 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 wo r recording.ycmr Notice of Commencement.
Signat e f Owner/Lessee/Agent =FLORI
Contractor/License Holder
ST E F FLORIDA4, �'
�ao � D � ^�
C OF - COUNTY OF w
n 75 x L'
a a LL
The forgoing instrument was acknowledged befor r -'; The forgoing instr ment was acknowledged befor r
this�day of 2025 by o C¢2 this�(� day of 201�by W'W s
¢>-w 9 =Va r
o ¢�W v
tt n
(Name of person acknowledging) "� (Name of person acknowledgingLol
i1i
ignature of try Public-State of - oriaa 61 (Signature o otary Public-'st6teo Florida
Personally wn OR Produced Identification Personally own OR Produced Identification /
Type of Idehtifi t' n Type of Identif � 'on
Produced C— Produced_
Commissio (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014