HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN O MU�E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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:
PRQP"OSEWNPRQVEMENTr,LOCATIQN „r
Address: g1o3 -s—/m p Ko-&1 Pi,y s CT I/ 1
Legal Description: 14 olida 1]Nes 5l� uSe ( ll Ll—o4 -s2-2-
Property
sz7-Property Tax ID#: _ 13 3 -- S o z- C-3 I O k-/ — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
_.
C 1 'AJ ura� a AP� .v 1
CG'STRUCTION INFORMATION
Additional work to be performed un er t is permit—check all that appy:
1
_Mechanical " Gas Tank _Gas Piping _Shutters° -Windows/Doors
/Electric Plumbing _Sprinklers _Generator _Roof
Total Sq'. Ft of Construction: Sq. Ft. of First Floor:. : .
Cost of Construction:$ FSU 0 Utilities: Sewer _Septic Building Height:
OWNER/L SSEE �g` CONTRACT
Name �'n S .�t� �4' t Name: l vats`"'�' � (1
Address: C Company:
ifu.J/`czsZPl-Pr
City: - vc`a` State:E� Addresses[ J a� w,�,✓ 2
Zip Code: 3 Y9S/ ax: City: E! c.2 Stater
Phone No. q oS— 355' 2— Zip Code: Fax:
E-Mail: Phone No 7 7 2-
Fill
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPRLEII%IENTAL: ONSTRUGTION LIEN LAW INFORMATION
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.
Signature of Owner Les ee/ ge Signatu o Co r t r/License Holder
STATE OF
COUNTY OF FLORIDA COUNTYSTATE
OF ORIDA_` T����
The f r ing instr ent was acknowledged efore me The fring instrum nt waasacknowledge before me
this day of 20by thisday of 20 by
�V
(Name of person a knowledging) (Name of pers n ac nowledging)
G�JV\ vl�__Nm 00 /A
(Signature of N ry Public-State of Florida) (Signature o Nota r u tc-S e of Florida)
Personally Known OR Produced Identifikation Personally Kn4 ,,, d entification
Type of Idem ANGELA
Type of I s. o a M HUFF
Produced N ELA H Produced. '•° YPublic Sta Florida
r Notary P011C- rlda a° My Com ass on#FF 234730
Commission FF 2347 0 Commission No:'� g�,,,,p,,,m'Expires may I
Commis si n • '' Y2(i5j�
J y s May 27. �� —« T"reu9h7Vatio
m�,.,i th.•�i:pr;Naliona!NMvs 45sn• nal Notary Assn.'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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