HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 7 �`
Date: 7 l t`�/ 2 0/(0 ff Permit Number: ( 6 6-7 0d l V
RECEOVED
Building Permit Application JUL 1 0. 201
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:
'PR4,6'x,� � � .
Address• 11yd �tQ2.t,Q .��� �� /�i' �r,�, �'�- �'f�'8 �y
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Legal Description: 1 / de— &J7,1 SZO 03/ Yd F '77 . 23 f'f 4 14
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Property Tax ID#: .3 �..3 6 d57 QQ0 Lot No. 1�01 E��Ii
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DE8-CR=I�P.T�ICIN ®F UN®RK ��
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Additional wobepertormed under t is'permit–check 011.that appy:
_Mechanical _Gas Tank _Gas Piping ' Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof-
- 7
Total Sq. Ft of Construction: f �.
.Sq-.Ft. of First Floor:
V 14lCost of Construction: $ Utilities: ... •Sewer _Septic Building Height:
®UVNER/'LE-SSEECONTRAORLL
_. NJ ii „ .
Name -k.» Name:
Address: 014,-Q Company:
City: —1-L . /,AUL State: . Address:
Zip Code: 3"C/9 Fax: City: State:
Phone No..W&/ 772 - 3 3 2- ^ O Y9 cL Zip Code: 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
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
LIEN
AWI;NFQRVAI®S'UPPLE / AL C®NRTQ
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-maMiecstrict 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.
Aa_,�/ter/ �/i(,. 4 —41"
Signature of Owner/Lessee/Contractor as Age or Owner Signature of Contractor/License Holder
STATE OF FLORIDA �. STATE OF FLORIDA
COUNTY OF ,�s'''ho;:. COUNTY OF
The forgoing ins nt was acknowledged before The forgoing instrument was acknowledged before me
this 41!Z-day o 20-& by this day of 20_ by
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cn
.,,.i 2 D%:7]
1 cn�
(Name of person acknowledging) w z c (Name of person acknowledging)
I
(Signature of N ry Public-State of Flori ) H (Signature of Notary Public-State of Florida )
Personally Known e/OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014