HomeMy WebLinkAboutBuilding Permit Application All APPLICABLt INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C2 Permit Number:
E75.. I� l
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:
PRO05IRS^ED NEPRO�EM;EN LOCATION: _
urAddress: /2173
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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L62WN%STR°UCTI'ON IN'FORMA�TI'0'N:
Additional work to be performed 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: $ SOD Utilities: Sewer _Septic Building Height:
OWNER ES-SE. CONTRACTOR:
Name .Sh�li�> l� kiEfL,J Name:
Address: 7'A Company: S1,y'/LZ�
City: el/�5SkC341S State: rZ Address: /s)l>V,,' !Cf ,��✓1.2
Zip Code:? .2-27 Fax: City: j-;i�/S >��Cd4Gs� State
Phone No. Zip Code: Fax: ?7Z ?2 7i
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail r I �!
from the Owner listed above) State orount 6 License X983,9
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUtP'F'LEMENTAL CON.S�'RIJCTION LIEN LAW INF®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.
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Signature of O ner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 1 STATE OF FLORIDA Lu COUNTY OF c �� S.Cl (? COUNTY OF
The f r oing inst. t was acknowledg efore me The f r tng instrum t was acknowledg d fore me
this ay of 20�y this ay of 20y
t
(Name of person acknowledging) (Name of person acknowle ing)
an\_ I iL� ,
I/ - t
(Signature of Nota Public-State of Florida) (SignaturelFf +tl • P blrc-
Personally Known I R uc entification Personally Kri'dWiti• M �ny� a fication
Type of Identificati6' �. ;9
Type of Identif'c tt,' o,111 RYp . r kplr 2 q� %a
ANGELA Produced ° d a
Produced '�� = M HUFF ,
•, * - 1C-State of Florida ""°�a/,yota ?07
N. a Commissl� F Commission No. '1AS eal)
Commission No. 'F ��°�' M Comm.E �r�I 234730 -_ a,�
Eorded r a12
7,2019
hmugh National Notary n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.