HomeMy WebLinkAboutBuilding Permit Application WrAAA171A=PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ppi_
Date: 61 Z11V2 Permit Number: 1 V�Q�s-`
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Building Permit App,licatn
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:
Address: -1005 int DOr-n `Zl N6& f 1 rX0L, L4Q
Legal Description: ODA POCK '" Uhl � 1 b\1- Xo a
Property Tax lD#: 130 k k"\o\011 ococ) Lot No. 1611,
Site Plan Name: Block No. \D°I
Project Name: f C� tom- (WOO
Setbacks Front Back: Right Side: Left Side:
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-P+-rrL* Yep wd d -ice L e, U,6+yot `i zW uy v ad S U l) fDofi -b
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Additional work to be pertormed under this permit-check a 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: I.
Cost of Construction: $ g Utilities: —Sewer _Septic Building Height:
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Name Name: J
Address: �( Company:
City: F-ya En C_rC,. State:_EL- Address:
Zip Code: C 1 Fax: City: State:
Phone No. c\6 Zip Code: Fax: -
E-Mail: 't1-\ hn Phone No
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Fill in fee simple Title Wolder on next p e(if different E-Mail
from the Owner listed above) State or County License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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.
igriature of er/Lessee/Con or Agent for Owner Signature of Contractor/License Holder
STATE O FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this o-k day of nNO64 ,20_b by this day of ,20_ by
(Name of persona nowledging) (Name of person acknowledging)
(S ature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced IdentificationNA Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced' 3 1 1` }I` mal" Produced
,SPRY AL"",� LASHAHNA INB��I) a Commission No. (Seal)
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Commissi * . *�: c-State of FloridY
N9. ro`a My Comm. Expires Dec 20,2018
Bonded 1-hr-o" 249
g taryg
n.REVIE S PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW EVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014