HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: / 'v ` 1 5 Permit Number: 'b V 1 " 0 01
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Building permit Applicati®n
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:
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Address:
Legal Description:V 4�1`e�- �, UA C i C Us'
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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iti I work to be,pertormed un pr ' is permit-check all t at app
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_Electric •s• .w. P,,lumbing.,” _;.Sprinklers _ ener..ator :.E,,..:, ,.T_,,,Roofy
Total z�q..F,t;:of Constt: tiior- Sq. Ft.of First Floor:
Cost=of;Caritruction $ 4'' . `��• Utilities: Sewer ,Septic Building Heig
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Name �' '?�/ �� �! r✓ Name:
Address: ` "'N)_sun cea SCompany: ._-- �� p
City: ��f �.t�Pc=i State: C-- Addre
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Zi Code: � Fax: � City: �.a j Lt.��f� State:
Phone No. )�l a'1 j "-ii _� Zip Coder Fax:
E-Mail: Phone No, Z2L1-_D—t-n V0
Fill in fee simple Title Holder on next page(if different E-Mail: (-4 f ��l�f1Y)P ftC
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from the Owner listed above) State or County License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SYt�PPLEN#EN��LfJ#t#ST#i{tT#fJN,I`#E4N°LAUD/ INFtiCFiIV#1�TC3iN h; � t� �z �'
DESIGNER/Ei�GiRiEER: Not Applicable MORTG,gGE COMPANY: (Vot 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.
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_Signature of Owner/ ent/Lessee --Signature of Contr or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
C i C'
COUNTY OF ST. LI,LC I, G COUNTY OF
The
g instr ent was acknowledged fore me ThMay
ng inst ent was- cknowledged,�fore me
ti of�GK'n ,20� by thiof k��e� Br 20r'� by
.dam" : :�i3O• r PVet�,.
CHERYL A.FINK CHEZFINK` � 1 - ate of Florida = Notar Pub=k---rne ofp 3 r "IMogb*.Expires Mar 28,2018 {iVame of p }E018m ss3on Ar Ff 104667 o.r .. Co miss
(Sire of.iilota: Pub' State of Florida} {Sigma ure of Nota ublic-
gnat ate of Florida}" _
_Personally Known OR Produced Identification Personally Known OR Pro7duced luentification :+
Type.of,identification Produced Type of identification Produced
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Commission No.t Q`t�vC,a� {Seal} Commission No.E ff 1014Seal J
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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