HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. j Permit Number: NO _�
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:
Address: Ui C4KACaZ QK A/.
Legal Description: �o� 6 �t1c r�r�o�t�r�c" ell� r t,�.�i►r�d 1 �1�i; e�►J Acct��'H9 y a
Site Plan Name: �� Block No.
Project Name:�'i//�tY! f
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormed under t is permit–check all tt appy:
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_Mechanical T Gas Tank _Gas Piping Gclllutters Windows/Doors
—Electric Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Q/ A Utilities: —Sewer _Septic Building Height:
Name tygn 1 Name: m
Address: 332Y 0/' Company: Co i.
City: 1 e;Cr'ce State: )cl Address; 2 3 vG
Zip Code: 3119119 Fax:—A,-/P City: C State:
Phone No.IS o7- 73Y 73-r zip Code:�3V 9 Cf 6 Fax: 72.1--!V61- {O�
E-Mail: A<IA Phone No 772, AlZ-02//1�
Fill in feesimple Title Holder on next page(if different E-Mail jQw?. Lut' tG
from the Owner listed above) State or County License-fCG
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: _Not Applicable
Name: Name:
Address: a f h 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 permitholder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and conts-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, 1 do hereby agree that I will, in an reit ects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Aioendments:
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.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ a COUNTY OF__ � c,
The forgoing instrument was acknowledged before me The f rgoing instrument was acknowledged before me
this�day of MXAV20_1� by this day of J 20L� by
nrvr.r> �✓b J G %h ✓t rE l r9 .r C
(Name of person acknowledging) (Name of person acknowledging)
2
(Signature of Notary Public- tate of Florida) (Signature of Notary publlc-S f Florida )
Personally Known Person --e-0017 WE161
ally Known
Type of Identificatio atm""' ewmPARMEEEE Type of Identificai i "-
: = Produced :*= WCOM=Underwrders
Produced ;.: 4 MY COMMISSION#FF 090774 's EXPIRES:
:g dI 12,2018 Rt eY� BondedTlxu Na"Public Undeftv*ers �onrUd Thru
Commission No. Commission No. ea
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.7/2014