HomeMy WebLinkAboutBuilding Permit Application [ AIF.APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED co
Date: Permit Number:
j W
y
- - 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 ✓
PERMITAPPLfCATION FOR: lac. L,V
I
i PROP,QSED �OVEMENT LO TfG..,N.
Address: 6 3 C-ck*'-iLno Dal R*i C7
)
Legal Description:
Property Tax ID#: Lot No. .
Site Plan Name: Block No.
Project Name: - Jc M S
Setbacks Front Back: Right Side: Left Side:
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a "t'va'e =E.eyw +'PKa,f.".Ttip-' '"- "` §7€`'^any,, y'•-_7-. «r-. _ � '"l. 5•» s L a'. ,.
SCO.N��zRU„�„!C1„,t�IIVFOt�N1A�lON �w L� Yak % ..; ��!
itiona wor _to _e pe orme un ert is permit-c ec a fi at app y:
_ 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:$ 1,�X>C) Utilities: _Sewer Sept'c Building Height:
r ;
.� � � . - s*d •'"=�4: �P c�.e^
i. � -� - . a , rra�.Yc. n�r':c
OWERjLE55r f'� .. R h
Name. Na
Addre Q Company:
City: Address:
Zip Code: _ Fax: City: ::::2C,,i S-t State: �L-
Phone No. -77Z- 9-71 - 07-79 Zip Code: _3 a0L8P Fax: �—
E-Mail: Phone No. $DL'3'-4C9.5
Fill in fee simple Title Holder on next page(if different E-Mail: . ey= aCa
from the Owner listed above) State or County License: l 2(u cv 5
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 apermit to do the work and installation as in
I certify that no work or installationhas commenced.prior to the.issuance of a permit.
St.Lucie County.makes no representation that is granting a.perm"it Will authorize.the permit holder to build the subject structure
which Is:in con.ie
any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your.Home OwnersAssoclation 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 o' r Notice of'Comm inncement.
Signature4fOwner/Agent/Lessee Signature of Co or/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF '�-�.-i. e;-e.- COUNTY OF �
The f r g.instru entwas.acknowledged before me The forgoi g instru ent was:acknowledged before me
olo
t:4 ay of _ 20_� by thll May of ate20�.-)by
(Name of person knowledging) (Name of person ae wiedging)
(Signature of NotaryPubli =State of Florida) (Signature of Notary Pc-State of Florida)
Personally Known ��OR Produced Identification. Personally Known_ tx OR Pgdlcgd Ilentificatian—
Type of Identificati - " - -, Type of Identificatio
QF
0DC $ J 4 �¢Commission No. a�y� oarOP,, �a Commission No: s �'= Notary Ptx i,� me of Fiorkh.•s y ts,, Commission FF 179630
: Commisslon# %'; My Comm.Expires Naw 30.2016REVIEWS FRO T IMR PLANS VEGETATION " SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE.
RECEIVED
.DATE:..
COMPLETED.
ev..7/2014