HomeMy WebLinkAboutBuilding Permit Application 1
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7'-cw:� U� , � Permit Number: (�
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce FL 34982 /
Phone: (772)1462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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PROPOSED INRR®VEIVI.ENT LOCA,T ON n q 4" . e
Address: 51o ,5- q , Dr— l X P 0_0
g p ► �- s CJS;�'�' O`7 a lS G oT Z Cp
Legal Descri tion: ►ate, ��Pr ��Sf�
c '51 k2s) R. R?R—I q16
Property Tax IID#: - I P >_ 609 3 2
O Y DDO - Lot No.
Site Plan Name:® �-f, Block No.
Project Namel ® ��i q✓� 1 L/er' cS' /ai (XS
Setbacks,, F font Back: Right Side: Left Side:
DETAILED DE=�SCR�I�PTION � F W®RK. y_
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CO'III IT, C 11' MNF®'R+IUTATI®'N:
Additional work to be perf rmed uncle this permit-c eck 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: $ ®, 3 tc) 10 O Utilities: —Sewer —Septic Building Height:
0111INER/LE-SSE: 4, � C� NTRAC`T® �� �� � � ���� i n.��, .,
Name Name: 0 G�� ✓�°SSi��a� (/�
Address: G 2rP-11 l k" Com anYk� `Ic
City: ^0 r S cU
• ��vsSln� L
p�� State: Address: (e p l O n w c a
Zip Code: '3 49 R2 Fax: City: f n ,-fi 101 r State: p-z-
Phone No. (o ( �(O(� ( Zip Code: �1�6'2 Fax:
E-Mail: Phone No '7 !:Z 2 k k.)p I )I (n
Fill in fee simple Title Holder on next page(if different E-Mail Ger ; �y1jci cS i yj I M C2o I o �'yv►�
from the Owner listed above) State or County License C 6C.
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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$SIJ�PPLEI�IENI'1#L CQNSI"fttJCI"I®N L ESN LAW INrFORMATI`ON:
DESIGNER/ENGINEER: _ Not A licable
pp 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.
Signa e:of`` . ,nezG Lessee/Contractor as Agent for t_ w5ignature,-o-f4Contracto/License Hold r m ....
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STATE OF FL !�y m STATE OF FLO :Rb
COUNTY OF m< COUNTY OF a
The f.r ng instr nt was acknowledge before i£ V5 The fpX g instr t was acknowledgecj before m g
this=day of 20 - by th' day of 20/� by N,
g axe� � fD�
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(Fe-)C W r h d P-) is ( n N
(Name of person acknowledging) Va (Name of person acknowledging)
QdA�2 V
(Signature of Vary Public-State of Flori6a U (Signature of Not Public-State of Florida )
Person lly own OR Produced Identification Personal] Known OR Produced Identification
Type of Ident' cat'on //. Type of Iden ' 'cal.
a ion
Produced ` Produced
Commissi n o. (Seal) Commissio o. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 712014