HomeMy WebLinkAboutBuilding Permit Application _ :rci1111L fvumoer:
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___ _ Building Permit Application
Planning and DevelopmentServices
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:
- PRQPC?SED 4NP -0 EMENT OCATlaN:
Address: ? ,{? _, Gy50�t ��m� rj. %'ems
Legal Description: SY11* G-U C,e
e 5.5 4 -- QCc1/ Is ��
l O 74 .-4,)
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Property Tax IDA Z C3 SU GJ"boy '12� ✓ Lot No.
Site Plan Name:' -Block No..
Project Naim'e..:
Setbacks Front �.`Back: Right Side:, Left Side:
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CONSTRUCTlO N -UR ATIQN:
Additional work to be performed under this permit—check all t at apply: /
_Mechanical _ Gas Tank ^Gas Piping' _ Shutters Y Windows/Doors .
—Electric Plumbing __Sprinklers �Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ R1-\<54 .0 G• Utilities: —Sewer _Septic -Building Height:
OUVN1ERjI SSE l«aNTRACTOR:
Name &ZACs`SGO 41we-r' iQe�e Name:
Address: Y 0 QQ5-1,7ve hive, Company:
City: iA' 4onoi,.. State: 1:7& Address:
Zip Code:-33W. Fax:—S'6 , 575- N3.6^ City: State:
Phone.No. Zip Code: Fax:
E-Mail: L' C 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.
DESIGNERjEN61NEER: 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 ty.
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 Horne 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 pians,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 tender or an.attorney before
commencing work or,recording your Notice of Commencement.
Signature o ner/Lessee/Contractor as Agent for Owner Signature of"Conttactor/License Holder
STATE OF FLOR DA STATE OF FLORIDA
COUNTY OF G> _ L \-
.> COUNTY COUNTY OF
The�fooing instrument was acknowledged(before me The forgoing instrument was acknowledged before;me
this\ ;; day of D6 N ,26�, by this " day Of 2Q_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary.Pu c-State of Florida} (Signature of-Notary.-.Public-State of Florida)
Personally Known OR Produced Identification Personally.Known, OR Produced Identification
Type of Identification Type of identification
Produced L. 1— Produced
Commission No. T�Asq-1�! (Seal) Commission No. '(Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.772014