HomeMy WebLinkAboutBuilding Permit Application All APPLIC�A'BL I(VFI �VE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( IP
Permit Number: 1
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 (z
PERMIT APPLICATION FOR:
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PROPOSED'INPROUEMENTLOCATIQN
Address:
Legal Description: / -L7 ( , a- (�'a a��t" �,,,flc l ��►� Aft),
Property Tax ID#: J �� Lot No. 7
Site Plan Name: Block No.—�
Project Name:
Setbacks Front IS',q Back: 6� / Right Side:/.d 7 S r Left Side:
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DEQ AILED DESCRIPTIONOF WORK G k ,g; _ 4hE r ,
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C®'NSTRUCTIONINF®RMATIO.N � _ � t j
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itiona wor to a per orme un er t Is permit-c ec a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: o Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
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OWNER/LESS"EE
iCONTRACTOR p� f°
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Name 'ip ry��t,b Name: ixr✓�c c:� a.A wz F;T c) r1-)b�E-
Address:. C R Company-AA P(Lrrz'-?LeiVr
City:T rIState:eL Address: '�-o-r, i rt e��5�u - `131✓v�,
Zip Code: Fax: City: <;-T , L,yState:l��--
Phone No. Cf -!T 3 —Zo-7 if d Zip Code: 3 q cy Z Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) _ State or County License (I. �•.�lD
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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'U PLEMEMT°:!.CQNS�oI-RS[h'(',=T1@Nf LAIN =NFO'RMATI "N:
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 recording our Notice of Commencement.
Signature of Own essee/Contractor as Agent for Owner Signature of Co ctor/License Holder
STATE OF FLORIDA STATE OF FLORIDA .`
COUNTY OF ���� COUNTY OF L(
The fopping instrument was acknowledged before me The f r oing instrument w� cl owledg d fore me
this day of 20y this I-F-day of 20y
ht �c�_,_, eA ?_,_-,as4,,(_mk^
(Name of person acknowledging) (N a of person acknowledging)
ail /,Y\ oaJ M
ure o ub' -State of Florida ) (Sign a M Aary li -State of Florida)
rsonall Kn `tsd,''P% 0 entification Per all Known dentification
Type of Identi i �«o ��= ANGELA MHUFF
- T e of Identification e.
Produced ;�1, ,,; Notary Public-state of Flo Pro uceasiNo/ gN6FC
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Sonde mm.Expires 4730 iyyC �'T Sra UFF
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE IVI
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REV
DATE
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