HomeMy WebLinkAboutBuilding Permit Application All APPLIC2AB E INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3 Permit Number:
4P rte.
- - _ 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:
NONE @'"S ED hNPR®UEIUIENT LOCATI®N:
Address:
Legal Description:
r
Pro pertyTa�c 3 ��ID3 " 'e-(J(Jjet No.
t
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D TAILED DESCRIPTIaN ®'F WORK.;
CO `STR'UCTI'®N INNI=®RMATION: Mimi MIMI
Aaditional work to be pertormed 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:$ Utilities: —Sewer _Septic Building Height:
01N� �ER/LE=�SSEE: ` C«®NTRACTO;R:
Name ►� e Name L=..N e�l.S �4KO��ea
Address: v �'1a.GC e ,� Company:,��^N dvi-s ,4,e /,v G
City: ' �� /-wt_CState: /� Address: S i D X
Zip Code:-9 -5 Fax: City: �� I elie-a * State:_�L
Phone No. ����� Zip Code: (�J ( Fax:
E-Mail: Phone No-7Z 7 ( (c/Q cCi
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License 9C2 el
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S� PPL EMENTAL CONST ' IJCTIO.N LIEN LAW I,NFORMATi4N:
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
commencipg work or recording our Notice of Commencement.
Signature of Owner/Lessegfcontractor as ent for Owner 'Signature of Contracto /License Howhr
STATE OF FLORIDA STATE OF�FLORIDA / r
COUNTY OF
L
u`C��l,��_ COUNTY OF Ste- Luc,
The forgoing instrume t as acknowledged before me The for oing instru ent was acknowledg d before me
this day of 20�j by this day of 20�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notar Public-State of Florida) (Signature of N ary Public-State of Florida) /
Personally.Kno OR Produced Identification � Personally Known ed Identification
Type of bnti,f iqn " Type of Identific °`^RY pGe' ANGELA
, EL HUFF Produced • ' :° M HUFF
Produce
• _
Slate of Florida •,c Commisslo Stat Aa1 Florida
Commission#FF 23 ;<< q;,�' h1Y Ca n r'Commisp:, �w^omm FY^•res May Commission No � mm.EXplr � 4730
Notvyq�s9 edthroughNationa►No27,2
019
arYAssn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014