HomeMy WebLinkAboutBuilding Permit Application I '
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED Q
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Date: Permit Number: -
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: .
Address: S. r ooenpo - LAVE 4 voq
Legal Description:
Property Tax ID#: ®3• CO 7X Lot No.
Site Plan Name: Block No.
Project Name: SCo7F 01\J7COc_
Setbacks Front Back: Right Side: Left Sidel i 1
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Additional wor t.
o be performed under this permit-check a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters i, Windows/Doors
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_Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:,$=:_ 7 0 Utilities: _Sewer.;,�,. Si ptic ,:•,,-,.Building Height:
1 11 lit I
Name :SC07T N01J-rAGVE_ .Name: AkJW1(JR_ EAJ6�L1'-1AAJAJ
Addresss: 830.'f�SPPKiAJGV1,5tk) bP\ Company;rl. c ull;; . E,Lkcty I GOTRA�A�(,!
.City: SOt1Tl-I NP'M. `'PT01U State: P/6 Address: 71R3 Gd.11oTir, PL
Zip Code: 19, `h Fax: City: �T ST tJCIE State: -rL
.Phone No. 27R- 334-7A3 Zip Code: 3 Y�IS� i' Fax:MQ_ �] �
E-Mail: Phone No. 7179— 17/
Fill in fee simple Title Holder on next page'(if different E-Mail: DCl/k/4A)C)-/� '/+TTI A/iJ
from the Owner listed above) State or County License: r—C 600 3079
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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.
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 ' s inspectiori. If you intend to obtain financing, consult with lender ora attorney before
commen ' work or recpfding your Notice of Commencement. .
Signature of Owner/ ent/Lessee Signature of Contra r/License Holder
STATE OF FLORI A)� STATE OF FLO DA
COUNTY OF ,,�� COUNTY OF
The forg ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20& by this day of 200 by .
(Name of person acknowledging) (Name of person acknowle ng)
G� .
(Signature of Notary Public- tate of FI 1(Illll (Signature of Notary Public-S to of Florid ,%i4111111111111j��
Personally Known OR Pr` 81�}�iffG�_ Personally Known ONN Z
R Produc
Type of Identification Produced ;•c� mberp2 /,o; Type of identification Protluced
Commission No. �*: (Se'all N;* Commission No. zi (Se 1g2 os
2: #FF 048192 •�= 2: •
O9'.ti Bonded ltiN �e:pQ �q••.Nod Bonded�bNtyi;.���,�Q�
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REVIEWS FRONT Z01 1'T }�'ERVISOR PLANS VEGETATION SEA TURiTIA/115 ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7 2_014