HomeMy WebLinkAboutBuilding Permit Application i
C1 1 n L ry urnoer: �`� �`��`
_ - 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:
1R9POSEI3 iNPRO\`14EME9T LOCATION:
Addr"ess:� 1�Grary C.uc�Y 1`.� �xerec aYS��
Legal Description:`Sry S o e i, )�i s 664- Z g CESS N.
S L a d- 6 z
Property Tax ID#: 1!4 .� Lot No.
Site Plan Name: . Block No.
Project Name:
Setbacks, Front Sack: Right Side: Left Side:
D TA LED DESCRIFTDON QFVI/®RK,
16 er1 c u) h G d eA.
CQNST
itiona war to ape orme under tis permit-check all that appy:
—Mechanical Gas Tank _Gas Piping __Shutters `Windows/Doors
Electric , Plumbing _ Sprinklers Generator T Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 1000- 00 Utilities:,!" ;i Sewer Septic Building Height:
Y
OWNER LEStiSEE: *ONTRACTOR:
Name VY-ens
Address: Q,8--c> 0S Oz, &� -V2 Company,: -
City: (,C State:Stater Address:`: _
Zip Code: 33YKF, Fax: ib/-!97S, �
77 -(13City: r.y. State:
Phone No.. - 6 g- 73z 7 Zip Code: Fax:
E-Mail: �fet,s?4r1 �` ���C!«ad: Phone No
Fill in fee simple Title Holder on next page If different E-Mail
from the Owner listed above) Sta or County License
If value of construction is 2500 or more,a RECORDED Notice of Cofnmencement is required.
i
DESIGNER/ENGINEER: Not ApplicableMORTGAGE 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.obtaina 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 Comme;icement 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 r n o e Notice of Commencement.
Signature of O er/.L ee/Contractor as Agent for owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF \ ��C�� COUNTY OF' .
The forgoing instrume t s ack owledg d efore me The forgoing instrument was acknowledged before me
this jc4day of .20, y _ this day of ,20 by
(Name of person ac nowdging) (Name of person acknowledging)
(Signature of Nota Public-State of Plorida) (Signature of Notary Public-State of Florida)
Personally Knowna0% uce " Personally Known OR Produced Identification
M HFF Type of
Type of Identificatioti:Not ry Public ASta euot Florida Produced Identification
Produced '• -
slon ff FF 234730
�n4;;hgP` My Comm.Exq,fres May 27,2019
Commission No. Bondedt4Q%res May
AssnCommission No. (Seal)
alli .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW. REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014