HomeMy WebLinkAboutBuilding Permit Application All APPLICABLI INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Dumber: 1 .00
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Building Permit Application
Planning and Development Services
Building and Cade Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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Le al Description: (..(. 'j
Property.Tax ID#: 9 `" 0 —6 Lot No. 1
Site Plan Dame: Block No. j
Project Name-
Setbacks Front Back: Right Side: Left Side:
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MecfiarncaI Gas Tank i Gas Piping, ",,;Shutters Wir�dovvsf,Doors
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_`Clectric —Plumbing _ Sprinkler§ .r.r'r ; `"666ieratar Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
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Cast of Construction:$ 51- 1)6' :..Utilitis �4SLekye wSepti :Building Height:
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Name. .� i FrFr /-zsyy Name:
Adc1r 7GT• s s .'„ r. -V'
'�eir,i• r' r! Jam(._-!J � l.�m'pa�'�/.
City: . Stater Address: aC & D
Zip Code:5 Fax: City: {�,:P'-"SE (Aie ! State:FC.
Phone No. – _00L _ Zip Code: � �1 J3 CC Fax:
E-Mail: Phone NV Q ® - 4
Fill in flee simple Title Holder on next page(if different E-Mail: M C
from the Owner listed above) State or County License:
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S�PPI,EMENTAE-C0NOT,RUCT10N >=17 -AW
EN {NF�� NIATl0 �
E s. �
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 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.
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Signature of Own4J Agent/Lessee Sign aturof Contractor/ ' ense Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY-OF, �, UAc i o— COUNTY OF Ste' �.fri C f
Thit�wforgoing instrument was acknowledged before me The f-forgoing instrument was a-knowledgi�d�efore me
- �{ ,.
t;is ° a}r of ire.nr �._ .20�by thi "day of {� c��Y1 (Z t3 _ icy _
c° I
ERYL A.FINK''of person,aikova ,? Notary u c- a ame of person acknowledging}"My Comm.Expires Mar 28,20 8 Co Ission#FF 104667ril
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(Signature of Not Public- ate a Florida} (Signature of Notary blit-State of Florida)
Personal) Known OR Pr Pr Known
Type of identification Produced , C09LSA F if y e o dentification Pro t rO�a''. CHERYL A.FINK _
.N =S (AOPN�t v^e^ 'r. Notaky Public-State of Florida
Commission No. ' CiirMm.Expires Ma 2� }� ion No,l —r ' My CT&%&xpires Mar 28,2018
'r+.,,o Com7Wission#IF'1 4661 �.,,,���t
Commission M FF 104867
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014