HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / 1
Date: Permit Number:
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_. __. µ. .. 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:
PROPOSED INPROUEMENT LOCATION
Address: 5e US 14 1 1- O'T „Z7
Legal Description: 6A/1--C A( rr. 1.4I'(c
Property Tax ID#: 0 00.2 0 0,02 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:. Right Side: Left Side:
DETAILED DESCRIPTIOOF WORK
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G G G !r !� L± r-iu
CONSTRUCTION INFORMATION
Additional work to a performed under this permit-check all that appy:
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: $ h� Utilities: —Sewer _Septic Building Height:
OV1fNER/LESSEE CONTRACTOR
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NameCX ev^tS .-.J MoI?it0C)mje R rk- i&ame: G f'r� �5�`
Address: /FJqI1 C nLLt ,,a.l f} ✓f_ 3001 Company: L* iri-/ S.-e-c -cAL elf
City: S 0 n.p,•. y ::r1'L ar State:FG Address: /0 4 f .!'cam j0i�}v^&, /9✓e
Zip Code: .3,3112 b Fax: City: P r L State: Fr-
Phone
ACPhone No. 3 0!5, ` S2. Zip Code: '�LLQ.,�� Fax:
E-Mail: Phone No CIS Z -Q II '>
Fill in fee simple Title Holder on next page(if different E-Mail S w► T�/ �('�ofc/iGP� �1 �rL•
from the Owner listed above) State or County License69,l ' v 1-9 6-22
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFOR(VIATION
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 herebyagree 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/Le see/Agent Signature of Cont ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S ,sZ COUNTY OF
The forgoing inst ent was acknowledged before me The forgoing instrument was acknowledged before me
this'M day ofy�,� 20� by thisa day of f1 ,201 by
(Name of person acknowledging) (Name of person acknowledging)
ts'ignatdre of Notary Publi State of Florida) (Signature of Notary Public- ate of Florida)
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Idetif �An
n,Personally Known Known R # gr:,r
=="»�oNotary Public-State of Florid Type of Identification '2°n�`�' Notary Public-State of Flor;;I; '
Type of Identification ; _• :• My Comm. Expires Dec 20,2e:t
Produced ;N; My Comm.Eicpires Dec 20,201 roducecl -
° Commission'#FF 177 ° °' Commission # FF 177249
�•`,`` Bo 249 %F of F���`��
Commission No. ugh National Notary Assn ommission No. Bondy r�r�iph rla:,anai notary Ass„ ,
REVIEWS FRONT ZONING. SUPERVISOR PLANS VEGETATION SEA TURTLE 'MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW 3 REVIEW REVIEW
DATE
RECEIVED h..
DATE
COMPLETED w
ev.7/2014