HomeMy WebLinkAboutBuilding Permit Application r A
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �I d
Date:y k)Q.A\�" Permit Number:
—"� - APR 12 2911E
Building Permit Applicati®n
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: To Select from dropbox, click arrow at the end of line
PROPOSED.IMPROVEMENT LOCATION:, ,.
Address: I .ron 1\/ -- - - - -
Legal Description: _ ` M !✓ N6 -Ir L. I ti I IND io
+A A-
Property Tax ID#: 0,5a-,C) Lot No. 9,
t
Site Plan Name`"' Block No. -44-2 l
Project Name:
Setbacks Fro Back.' _ Right Side: Left Side:
DETAILED DESC1N
RIPTION OF ORK.. i
CONSTRUCTION INFt7RNiATION. :,
itiona wor to a er orme under this permit-check all appy:
F]HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
Electric ❑Plumbing Sprinklers I Generator F]Roof
Total Sq. Ft of Construction: Sq. Ft.of First
Cost o€Construction:$— '_ - UfiIities: L�JSewer USeptic Building Height:
OW RILESSEE: CONTRACTOR
Name_ _ !Name:
Address: I Sog N 1 � Company:
City: 4- Pl 4FCLIeC2 State: .,�- Address:
Zip Code: j- , Fax: /� City: State:
Phone No. Zip Code: Fax:
E-Mail:_1a)CCk1 u -�. P'y� q Vin[;I Phone No.
Fill in fee simple Title Holder on next page(ifr'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.
4 7
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
commencing work or recording our Notice of Commencement.
4Siurre of Owner Lessee/ ontractor gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was.acknowledged before me The forgoing instrument was acknowledged before me
this day ofd 20AI�_ by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub'c-State of Florida_,)� (Signature of Notary Public-State of Florida)
Personally Known A�irProi ced Ider4 r etig to o1 F1or1d j ersonally Known OR Produced Identification
Type of Identif ation ?'P;Q,,, pubF
Notary �Xpires Oe— � ype of Identification
Produced tli D le :/ ". , Comm1Ssion#EE 85a�6Ass . roduced
= ,Po` Gom htou9hNatioaalNotary
Commission No. 6 F � Commission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014