HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE II M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /(c�- �I 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:
P�ROPC?SE 3 1'NPQ1lEMENTl:QCATIC?N� NINE
Address: '� �t�2
Legal Description: 'L-�I �j���-1G SO, �11IL'd 'f'Q ' t,(�t f S �r-a/ MI
P144 6opK �(, /� � 31 -tAe /fix�h e Xec�rd' o Si Lucyc 00
Property Tax ID#: 3q19 S40 t7aS47 000.3 Lot No. .3.3
Site Plan Name: Block No. S 0
Project Name:
Setbacks Front Back: Right Side: Left Side:
Vin` F
DETAILED D`E CPTION " F 111/aRKA
CCINS�TRUCTI(7N�INFORIUTATION
itiona wor to a per orme under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _nSpprinklers _Generator _Roof
Total Sq. Ft of Construction: a flme., Sq. Ft.of First Floor:
Cost of Construction: $ p4'� Utilities: —Sewer _Septic Building Height:
VN`N;ER LES SERE, im
Name OA/ e__/-9 Name:
Address: /117 vim', 5,P1-A2 o0e- Company:
City: J0aAT S! L&4e-1E State:; Address:
Zip Code: 3 W Fax: City: State:
Phone No. 9 1,SLf 1662- f-1-69 Zip Code: Fax:
/��1
E-Mail: rV els ll" a-yA/y pop: Cts Phone No _-
Fill in fee simple Title Holder- on next page (if different{ E-Mail
from the Owner listed above) State or C my License
if value of construction is 2500 or more,a RECORDED Notice of Comme "ement is required.
SIJPPL�M,EFNTAL C®NS�TRGC �.LN�LK1W,�`�INFOR�IUTATI',�� �I.
DESIGNER/ENGINEER: _Nat 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
WARNIN O OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
Iml ements to your prop y. A Notice of Commencement must be recorded and posted on the jobsite
b ore the first inspectic . If y u intend to obtain financing, consult with lender or an attorney before
C mmen in ork or re rdin our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I tS/ - (,ucler COUNTY OF
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this day of— U20L6 by this day of 20_ by
(Name of person ac nowledging) Name of person acknowledging)
PAJI\/�J 1r-11 .M —
(Signature of Notary - tate of Florida) (Signature of Notary Public-State of Florida)
Personally Known F OR Produced Identification Personally Known OR Produced Identification
Type I 'f' ;} Type of Identification
Produ d .,u1 =ANGELA M HUFF Produced
Notary Public-State of Florida
Comm 261 * »•= Commission#FF 2347p9eal Commission No. (Seal)
'•,9.F4F�°a°= My Comm.Expires May 27,2019
Bonded through National Notary Assn
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