HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:, �� Permit Number: aci • ��_�) ll
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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 Residential V
PERMIT APPLICATION FOR:
PROPQSPR
ED,tNOVEMENT LOCATIQN �� �_ s ��, ?F4 .
Address:
Legal Description: �n��o.� ei�lt� GS�ti�eS - ()n1+ '01
Property Tax ID#: 3 If ox -IQ l� ' ols 6 - 00o-� ! Lot No. � I
Site Plan Name: Block No. 7g
Project Name: d
Setbacks Front Back: Right Side: Left Side:
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1""330 .
DETAILED ESCRIPTION OF WORK x
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66
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CQ(VSTRUCTIC�N tNFORfIUTATION k , s
Additionall work to be performedd under this permit-che—ck all that apply:
_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 0l C)0 Utilities: —Sewer I_Septic _ Building Height:
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OUI/NER/LESSEE CONTRACTOR '' �. ; K F
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Name{ enr4k 1tiv,a^- Name: Wi Inky►% (S
Address: Po Bo)c I Ll3 43 Company: Mi I I:$
City: Myr- le State:SC. Address: I4lS %W 6006", r Ave
Zip Code:. 2-°I S�� Fax: City: 06_;� StLve-(e- State: F-LL
Phone No. Zip Code: 3q'IS3 Fax:
E-Mail: Phone No 464' _)l(D
Fill in fee simple Title Holder on next page(if different E-Mail S (li ICm
from the Owner listed above) State or County License idt- 11M 16-7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLIVI�NTAL CONSTRUCTION LIEN LAIN INFORMATfOfURP
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.
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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/Contractor as Agent for Owner Signature of Contractor/Licen'se Holder
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STATE OF FLO1 _ STATE OF FLORIDA
COUNTY OF ° COUNTY OF ��4
e e
The for oing instr/� ent was acknowledged before me The f oing in r ent was'acknowled gd before me
this `� day of U 20 )( by this day o - 20ib by
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Z(Neerson acknowledging) a of person acknowledging)
ign ture of Notary Public-§Wte of Florida) igna ure of Notary Public-S a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced I
Commission No. (Seal) Commission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ;I SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW j REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED I
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