HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
' _
k. K",
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:
-
..�..
Address: 71 DC-�)O /` %k,)y,g 3 11 S
Legal Description:.
Property Tax ID#: l 3 0 l ` 6 161- b 111 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
. ft
,ra s,
1
R
Ck, a�(. k�� ((--j sr fbCTY
41
CtSTRiC� II�tQ�l�+! �(tl02,5;.,' .F:�`c .<.x:.«_`
Additional work to be performed, under tis 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:$ r'2 n D - U O Utilities: _Sewer _Septic Building Height:
-caa ,-�
Name C tiT,_ .L Name: _ ).�rAr � ► c�l�
Address: `7 7 1 N l�v�L(_1"� C y -fir yam_ Company:_'; F'v e c�v� 1_
City: P1AC 1-F �� c,2-� State:�(, Address: ' (cn q 4
�,�n g�_r
Zip Code: i b Fax: City: -Pe>.tr Si LO -e State: FL
Phone No. Jr I �, Z D 3� Zip Code: Fax:
E-Mail: 00fr- wv 1 rv, Phone No t —LA
Fill in fee simple Title Holder on next age(if different E-Mail n(C.
from the Owner listed above) State or County License ® I?U !y 5 77
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
gr
DESIGNER/ENGINEER: Not ApplicableMORTGAGE COMPANY: _Not Applicable
_..__ _.. N ----_ .,_ __ . -------- --
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.
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 mayrestrict 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.)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 wfull 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 Owner7 Lessee/Contractor as Agent for Owner Signature of Contractor License Holder
STATE OF,FLORIDAN STATE OF FLORIDA
COUNTY OF (-� > L �-- COUNTY OF
The for oing.instru nt w acknowledged before me The fo ng instru ent was acknowledge before me
this'day of _ `20�y this day of 20�y
FAL.00SZ,t V. J A 'FA a—n . c:L 1
(Name erson acknowledging) (Name of person acknowledging)
�t�,
(Signature of Notary.Publi -State of Florida) (SiQnaurl of Nota. Public-State of Florida)
Personally Known 1.
OR Produced Identification . Perso ly Known OR Produced Identification
Type of Ider?'fic Ty p qf,), ication
Produced <rav nye, -Z
Pr,'
U F Rte.
4 ;� otary Public-State '"
Com #F� orida o-.� t kloNor' .(Seal)
Commissio •v; mission
FOF s> om 30 ''.oFFt R,\, C pb
Ronrled thm�Expir,. May 27,2019 4tity��o�mlic s� yUFF
s� .... gh Nati
REVIEWS FRONT ZONING SUPERVISOR - PLANS VEGETATI'O,I, Ma �RoTpU TLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ���✓ .,.,'� W REVIEW
DATE 7.
RECEIVED
DATE
COMPLETED
ev.7/2014