HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INVO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ Permit Number:
„u
..� . _ .- 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 I/
PERMIT APPLICATION FOR:
PROPOSED:IN P.ROVEM ENT.LOCATION
Address: 0 Lr0
Legal Description: a2d, (JL Of 6_ 2 �2
Property Tax ID#: IlJ ) Moo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: 2
8 , Left Side: /8
DETAILED DESCRIPTION•.OF WORK
1 � tKso icl
re-oldeQ -4' - c -_w4n '�ek' I- Y_6 L01 I hu
CONSTRUCTI `` 'INF k ' A_TION.
itiona wor to_ e pe Orme under this permit-check'all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator I n_Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ / }moi V Utilities: —Sewer —Septic Building Height:
OWNERjLESSEE CONTRACTOR:
Name bajAn ALjaj Name: l
Address: u) I s� Company: 11'5 Of L° .UC
City: E-Pie_rC_2 State, Address: I ISO13c1�1�tc�—e.
Zip Code: L ��;I Fax: City: 1� 1.f 0e, Stater
Phone No. € n I- 3 d' -rD- ' t 42 Zip Code: L� Fax-7-72.-344 Iml
E-Mail: Phone No 9Oa ',314L1--TX
Fill in fee simple Title Holder on next page(if different E-Mail f71+-- b i lies -, n.CI)rY�G'C�i Sf-r��'J-
from the Owner listed above) State or County License t�� iL `) 129�n
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL`CON'STRUCTION 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 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.
ignature of Owner/Lessee/Agent ignature of Cont actor/License Holder
STATE OF FLORIDASTATE OF FLORID JiLk�
COUNTY OF COUNTY.OF
Theing instrun, s ack owledg before me The ing instru as acknowledged before me
this. day of / 20by thisday of ? 20RPby
(Name of person ackno ledging) (Name of person acknowledging)
i
nJ
(Sig ture of Notary P lic-Stat f Florida (Signa re of Notary Pu/blic-Sta of F ride)
Personally Known OR Produced Identification Personally Known f/ OR Produced Identification
Type of Identification g:%jKRX_4,, Melissa McLeod Type of Identification Melissa McLeod
Produced NOTARY PUBLIC Produced
,, o =�� n NOTARY PUBLIC
STATIC OF FLORIDA ,� �C ,
� _ C(5eai�;F5^®301 7 Commission No. 4xa 2a'I'E OF FLORIDA
Commission No.
>•• ,t RMMf.FF030187
Expires 6/2312017 �"f'°u°�s`�6" EYftatzc
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014