HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: I� co 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:
PROPaSED INAPROUEM1EIT LOCATI'O'N;
Address: �001 ®. 4?k10f
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESC fPTIONF 1NORK:
T
Ap A:�GZJ #f_1Y
C®NSTRjIJCTI'ON I.NF®'RIUTATION:
Additional work to be pertormed
, under this permit-check all that appy:
PrAfinechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
alp p
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
Al IN
ME 10M
CONT ACTOR;
Name 7t-hL0 44-s hLA-_6o-,drt41_-' Name: O- Al
Address: 21o "z-// .Q }lG f�1C l L r�' Company:
City: /�� /i I-e x-WE State: Address:
r
Zip CodeFax: c� City: State:
Phone No. !/7Z V/ Y-2- / 0 Zip Code: Fax:
E-Mail: 7 D lgl �c ,����C-0�� Phone No
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.
S PPLEMENTAL C®N45�1"RUCTI�N LEEN 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 fir ' spection. If you intend to obtain financing, consult with lender or a.n attorney before
commenci w rk or recording our Notice of Commencement.
Si ature of O ner/Lessee/Contractor as Agent for&vner Signature of Contractor/License Holder `
TATE OF FLORIDASTATE OF FLORIDA
COUNTY OF -:) COUNTY OF
The forgoing instrum ,t as ack wledged before me The forgoing instrument was acknowledged before me
this day of \J 201eby this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
claL� li:::�a di
(Signature of Notar ublic-State of Florida ) nature of Notary Public-State of Florida )
Personally ngu ""••., �� Lq UFF
a� 0 hfAt-r!'!i#' nZ Personally Known OR Produced Identification
Type of Id - N tary putillc- tat o Florida Type of Ideritification
Produced ` , - - Produced
=q; a°.My comm.'Explres Ma 27, 019
Commission to.,;"._ ._
Bonded hNat! nal �ssn. Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014