HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dater 1`� `� Permit Number:
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R E C E R"H AUG 19 7636
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:
PROPOSED tfVPRQ1/EMENT LOCATlQ M,F
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Address: V-1 Ci
Legal Description: '
Property Tax iD#: 3 `� -° —` �- -"° Lot No.��
Site Plan Name: 1 his` Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAtLE13l3ESjCRIPTfON O,d;WORK t,
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CONSTR-b! UCTION iNEORMAT10 S aW
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Additionalwork to be pertormed under this permit-cnecK all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
_Electric _Plumbing _Sprinklers ,Generator Zoof
Total Sq. Ft of Construction: �dd Sq. Ft.of First Floor:
Cost of Construction:$ 6001.Dd Utilities: _Sewer _Septic Building Height: 1:Ak
OWNERLESSE a CTO '
CONTRA R �:
Name Name:
Addr ss: O _ �P Company: L
City:�6�� t G� - _ :tate: Ft-- Address: pl
Zip Code:3L6(Q)"Z, Fax: City. State-la—
Phone No.777�� QZ�"'° Q_ t� Zip Code: Fax: -->
E-Mail: Phone No'77 I-S
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County icense C�C 0S; s�
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is req ' ed.
SUPPLEMENTAL CONSTRUCTI N"UENIAW,IN {ORMATION-
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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 o caner/Lesse /Agent Signature of C ractor/License Holder
STATE OF FLO/R�DA STATE OF FLO I A
COUNTY OF _ Lye\� COUNTY OF �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisl':N day of_ Q010\ 20 6 by this VA day of U ,201 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub' State of Florida) (Signature of NotaryP blit-State of Florida)
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Personally Known OR Produced=f*RAr.#ic5V6A S da � Personally Known OR Produced.IdentificationG—',. ~ 1.,
Type of Identification "-_`;;� P,&\r,-state o16 Type of Identification yyDEANNA SNENS
Produced V D�'- ;;5>`"P"�<<; Plotary�m Expires Del Produced Public State of Florida
r—��(a(y )016
PAy Dommission#EE otary Assn., —t���_\I, icy Comm.Expires Dec 1
Commission No. `��`��' �(5eal)9°��at(�°a,— `r�� Commission No. �C � ! Y� comrr(wg�l� #EE 65876A
ough alional Notary Assn
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.