HomeMy WebLinkAboutBuilding Permit Application All APPLICAB I FO MUST BE MPLETED FOR APPLICATION TO BE ACCEPTED +
Date: --T Permit Number:
1 -107 �s7— �
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:
PROP®SED INPROVEMENT LOCATION:
Address: 600.1 /A31 -zG Dn,11,5 ZL �ir� � . FL �?y9�
Legal Description:
Property Tax ID#: O Lot No.
Site Plan Name: Block No.
Project Name: Cc/ /D o/L Soo 6 c��/� y�
Setbacks Front y'I Back:�_Right Side:_2LCJN 1-Left Side: /
DETAILED DE�-9CR�IP I0(V O WORK:
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10460051TIMUCTIMMNFORMATION:
Adclitional work to be performed under this permit-check all 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:
Cost of Construction: $ [ goo o Utilities: —Sewer _Septic Building Height:
O W1NSIER/LE;&SEE: C®'N RAGTOR:
Name Name: OGt/
Address: 600l 6i v-c Dr. Company:
City: /--Z- - State: Address:
Zip Code: 3 ty 1 g"c,?- Fax: "V 'J iz City: State:
Phone No. 77,-2- YC./- 3 `9S-S- Zip Code: Fax:
E-Mail: o4 D4 DEC/a0 y,l M4;L -Coy! Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County Li ense
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5UP'PLEM�ENTAL C®N�STR�UCTI'0N LIEN LAW IN'FORIVIATI'®IN.
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 recon our Notice of Commenc�t ent.
Si ature of Owner/Lessee/Contractor as Agent for Owner Signa a of ontracto /License Holder
STATE OF FLORIDA STATE OF_LC-4 COUNTY OF 0%IDA
FL
COUNTY OF
The for ginstru=_0_,20_L
knowledg d efore me The forgoing instrument as acknowl dged before me
this� of this day of 20_ by
(Name of person acknowledging) (Name of person acknowled ing)
(Signature y Public-State of Florida ) Signature of Notary ublic-State of Flori\-fication
to�Personally `°:': OR DkftWWV UFF n Personally Know OR Produced IT e of Id fi bl _ Type of Identifi ationProduced � i State of Florida Produced30
u"Im.Expires MaCommission No. Y 27
o nded �9INationall � 019 Commiss' n No.
REVIEWS FRONT ZONING SUPERVISOR PS
IEVEGETATION SEATURTLE IVIANGR VE
COUNTER REVIEW REVIEW RE W REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE _T
COMPLETED 7
ev.