HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
Date:" Permit Number:
D JUN 1
REM —
Building Permit application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34.982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: �ArC o �� ke-c �
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Address: 3 ^ JO �7oti� tjooj
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Legal Description:
Property Tax ID#: / -! J�- / Uy 00 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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A i iDnal Work to be pertormed under this permrt-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric --1/Plumbing —Sprinklers —Generator — Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 2-O6• U 0 Utilities: _Sewer _Septic Building Height:
QV,IItEf� :7ESEE =O�TTRLT
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Name SU Name: ( tI.-z� ..iS�.�St7✓1
Address:�� 31�'� Jo �`YG-�'zJ �� Company: re's Ta/� JBSd "
City: Address: 1701 S 37
Zip Code: q� L) Fax: J City: F� � r-L, 'e1' State:
2, �s 5 �, T 1
Phone N 1 ` 7 � / Zip Code: 3 Li � Fax:
E-Mail: Phone No�771� PQ 1 30-
Fill in fee simple Title Holder on next page ( if different E-Mail �l
from the Owner listed above) State or County License
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 rk or recording yoUr Notice of Commencement.
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gnature of Owner/Agent/ ee/Contractor Signature of Contractor/License Holder
STATE OF FLOgDA STATE OF FLPZrIA L Uc �
COUNTY OF A'- 1--�C � COUNTY OF SS
The forgoing instr ent was acknowledged before me The forgoing instru ent was acknowled ed before me
this\1 day of d�1 20 by this�� day of UyN v' 20V by
(Name of person acknowledging) (Name of person acknowledging)
I
(Signature of Notary.Pu lic-State of Florida ) (Signature of Notary Pub ic-State of Florida )
Personally Known OR Produced Identification _Personally Known OR Produced Identifies
Type of Identification , ype of Identi nation '" GIVE—
' DEANNA
Produced �l. 9L. _ _ ` atVENs roduced �- L h state 01 Flo[i z ''
`� ptANNA Y P11. Public
State of florid ,o M tao fres Dec
public 16 2p 6 .j z" _MY Domm.Exp EE 858761
Commission No.�� B;,, v Ues Dec �, mmission No. ���i�' ission# ss
. Dom,ExP
2= •'=Nty ommisslon#E at Noaa y A sn. .',;QI °, Bonded Through National Notary
Nstton
FRE
REVIEWS FRONT � NCNG SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTERVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
`i
DATE
RECEIVED
DATE
COMPLETED
e T 772014