HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECE1'_:D JUL 12 NIB
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:
PR (}SED INPROUEMENfiLOCATION
,
Address:
Legal Description:
Property Tax ID#: Z J - / o 6 G / -7'=060- 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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13!17 Dl DESCRIPTION O . WORK
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CONSTRUCTION INFORMATION 71
itional worK to be pertormed 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: $ I �J(J Utilities: —Sewer —Septic Building Height:
OWNER/L`ESSEE �' CONTRACTOR: `
. ,.
..,
Name Tk6 W 41) S kodk Name: `L
Address: Q,-10Y i)l Company: I I
City: `'><• State: Address:
Zip Code: 3 Fax: City: E¢.Pa m State:_E_L
Phone No. �` '�a�l b �� Zip Code: 3 y 5�f 2 Fax:
E-Mail: Phone No. `( (--(,-6 Z16
Fill in fee simple Title Holder on next page (if different E-Mail: Lo. K„I6 Ilse_Q 4d
from the Owner listed above) State or County License: t;�7z5__(7:7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
$°ac�' �: r
S ag PPLEE iENTAt.CONSTRt1CTION L1h,N LAIN INF
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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 Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO IDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowled eco before me The or oing instr�u nent was acknowledged before me
this0� day of l'J1 Ng 201' by this day of JJ 1 y J 20),(� by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blit-State of Florida) (Signature of Notary P lic-State of Florida )
Personally Known OR Pr ducedaldE (�f��q,tf S _ Personally Known OR P�or�uce&rde'�[iAtfvc�a 1p s
Type of Identification Prreduced � State of' Type of Identification P ode �s;L, � state of Florida
y 5 '', ycturY fresBC
ot, r�.Exp 8587b1 a pf; Co m.Ex fres Dec 16,2D1b
Commission No. = .A. • . MY C � Jaron#,EE" o1ary pss� Commission No. �b "J; t Col�.Mg �#EE 858761
` e,orded Strougk,N;°,�ti N� National Notary_ n c
REVIEWS FRO14 ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
—R—ev—.7/2014