HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: e' \r' Permit Number:
RECEIV--D jtu�J 2 7 616
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: S(�t
Address: S:9 60 V-kokxA
Legal Description:
Property Tax ID#: _{�\— ��-( �000,>,—®pp-�" Lot No.
Site Plan Name: Block No.
I
Project Name:
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTtON`iNEORM'ATION r t
r
Add
itiona wor to a pe orme 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: S Sq. Ft. of First Floor:
Cost of nstruction:$ 000, e) � Utilities: _Sewer _Septic Building Height:_�
S1VNF, LESSEE T
CONTR�4CTOR.
ame l �nName: o�
Address: S p6,t_�_ g, Company:
City: ` Cpm State: Add resl:
Zip Code:�L 7 Fax: City: Ci State:
Phone No. Zip Code: ZJ(44jP)Z�- Fax:772 Ory
E-Mail: Phone No -7 7Z— -3S3S
Fill in fee simple Title Holder on next page(if different E-Mail VJ
from the Owner listed above) State r County License CCL
if value of construction is 2500 or more,a RECORDED Notice of Commencement is requireck
FSUPPLEMEt•IT�LFCONSTRUCT�If}IU�,1;tElU�LAW�I#�FQf�MATt`(�7�i:���;� F� � �� , � , ��x,: fid' k Y �-��
x:, ?. .i..>.� . ..''., "..-,.,:A., ,_:Z.} t ._,.:,, �,.."a. a�:i:.-•-...,t1,r;: x � ..' zr���',,:'„EY.G,,.7tl.r s ..?,'f..,. "k> ?w;9:.:..� y t k,� � �
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,l 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
commencin work or recording our Notice of Commencement
SignQ16re of Owner/Lessee/Agent Signatur of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S t-l W GL COUNTY OF 'c+c LU(�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisaday of g\r< . 20_VG by this an day of 26 by
Qs
(Name of person acknowledging) (Name of p rson acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification \ Personally Known OR Produced.Idec#tvi c�fi�\d'a k'
Type of Identifica ion tJs `\da Type of Identification �PNNa \ale°� 20 —
Produced °\F\O o�6 Produced
oat1�� Oe 6\
OEPNN� �i
Commission No. `�S`�1rps � �P� Q�teS ��05aa�yPSS, �comm
ission No. G� „,.,. :��y r _40a air°°a\N
�' t�a�e�6•,My G° tn�s`' r1o”°;:,'„°:.,._ (t1 , �� �`=�j,_ _ °�ded .�
Q L }}��J l _ neo
REVIEWS FRONT;; . 7C3R[1iVG'c- °"SUPERVISOR PLANS VEGETATION, y SEA TURTLE MANGROVE
COUNTER+ ",' E IEIN REVIEW REVIEW REVIEW ` REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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