HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -ZS� 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)462-1553 Fax: (772)462-1578 Commercial Resld�ential
PERMIT APPLICATION FOR:
Address: �IOSkcowc=� '36(_ I
Legal Description: /i,tJC�00k �G4k Un' `� �� � k 0� 1S -74
AkQ 12 13 ja N u{ 2-75 3 - 22.9101 Zia
Property Tax ID#: 301 -(P 3 r 6 40 2 - CSS Lot No.
Site Plan Name: Block No.
Project Name: Lynn ®' '20 efi
,Setbacks Front Back: Right Side: Left Side:
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iaa o L x'Sk Md,h LAK (1) s ' 1Oidc 4, e .I4. (1 3 ' wth
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WiRonal work to be pertormed under this permit-check all tat 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:$ Ud Utilities: —Sewer _Septic I Building Height:
Name .�A r1 0 Name:
Address. Sei ds ccor Woo (7� Company:
City: ev• 4pi ej ct•- State:F(' Address: IDO(0 -
Zi Code: 3�-lal —
p Fax: City: iJ I Stater
Phone No. 3_5 -53L)G Zip Code: 5c_+96a ( Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License I SaaC)
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: I _Not Applicable
Name: Name:
Address: Address:
City: State: City: ! State:
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do thelwork 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 Amendmelnts.
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 a'nd 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. (�
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Signa of caner/Agent/Lessee/Contractor Signal of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDP
COUNTY OF r"tom ti ��� COUNTY OF -f'12 �`'
The fo oing inst yment was acknowledged before me The for in ginstryment, as cknowle2dgee before me
this day of f VIyC� 2d� by this ��`da of �r►�'ll4 �qllby
uc ma,"
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-.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 " C1 17ARETH EVANS Produced—.. --
Notary Public.-State of Florida "Y N
ELIZABETH EVANS
Commission a' Expires(Wale.2016 Commi i$ •°: -State of F(flialal
Commisslon#EE 16 957 My Comm.'Expires Mar 19,2016
- — '•%r Commission N EE 180957
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER 'REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED C
DATE
COMPLETED
1ev. 7/2014.
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