HomeMy WebLinkAboutBuilding Permit Application Y{
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
1: Date:31 q`\ _0 Permit Number:
` R E C E 1 VE D OR 0 91016
G Building Permit Application
F 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 —
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PERMIT APPLICATION FOR: U aC
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E PROPOSED IMPROVEMENT LOCATION: g
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Address`. I
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I Legal Description: r o 12C 2w !
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Property Tax ID#: 4\O—fscES—'b l l"1 ' O Lot No.
Site Plan Name: Block No.
Project Name:
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Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIa�N 0 WORK t
Pay aQ� 1 A `
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CON STRUCTIONIt�t ®RMATION �
Additional work to be performed under this permit—check alTtTiat appy:
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I Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
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Electric _Plumbing _Sprinklers _Generator Roof
I Total Sq. Ft of Construction: 1C9 J to Sq. Ft.of First Floor:
Cost of Construction:$ r,-S!450.kQC Utilities: —Sewer —Septic Building Height: -
'OWN
ER/LESSEE• n ,
CQNTRACTQR. ,
Name be-r (�flmaS -�rYrtr,a�a` e,� Name: (4VK�6oc
Address: 7 o Lor-)* CX 2 C rQ P-A Company:SPsYY>-�
City: = State: Address: i�l f\/�!U►/C`��•3-� L
Zip Code: oqA Fax: CityS Cr State
Phone No. Zip Code:��\�1gCS? Fax:
E-Mail: Phone No. - 529�'
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CtiP1C.
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUP LfMEN'TAL C+t�7NSTRiJCT�ON UEN LAW 1N 0 I: -
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address: Address:
I City: State: City: _State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
I — —
C Name: Name:
i 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.
s,
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
commencin work or recording yoyr Notice of Commencement.
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( Signature Owner/Agent/Lessee Signature of Co or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f r oing instrument was acknowledged before me The forgoing instrument was cknowledged before me
( this day of 20_�i;p by this ay of 20_L by
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(Name of person knowledging) (Name of perso knowledging)
i (Signature of Notary PubState of Florida) (Signature of Notary P
ublic Stto of Florida)
fPersonally Known v �� _ Personally Known identification
I Type of Identification r® Y N Type of Identification _ V
DEBORAH RUSSELL
=•. My Comm.Expires Nov 30,2018 .
Commission No. ="?" 'o: Con�� 31�n # FF 179630 ' Commission No. � + �' Notary Pel( p )ate of Florida
y Comm.Expires Nov 30,2018
Bonded through National Notar Assn.
-�--9 y. �i�°�.• Commis C�
onded through Nation I Notary A
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION S A VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW'
DATE
RECEIVED
DATE
COMPLETED
-Rev.7/2014
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