HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF JUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 0a:z
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:
PR®POSED I'NiPROV'EME'NT LOCATION
Address: S- 6-D
Legal Description: Sgg� LAN /6">rL'�eAs JGI K 15- L J?
Property Tax ID#: 2qo&'�Vll —b-186-600-1 Lot No.
Site Plan Name: f7� ( Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DEaSC °IPT 0 OF WOR
NMI
C*Q`NSTR�U TION IN�FO.R�I1/IATI`®N':
Additional wor to be pertormed 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-s �.�J �. � Sq. Ft. of First Floor:�"-3 a V
Cost of Construction: $ Iyd�• Utilities: _Sewer _Septic Building Height:
OVV'NER LESSEE: c� CO`NTRACTOR•
Name V`5 -'S�ti� J Name: ��(.►✓lL.(�Pl�/
Address: 14110 ' kxV'•lce-- Lv\• Company:
City: State: Address: ZbZ
Zip Code: Fax: City: `TO'ze' State:-c-z::-
Phone No. Zip Code:-3 5175or Fax:
E-Mail: Phone No L-Z21 L) 331-70d
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License C&," '1,5f3J91>
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C®,NSTMEANT ION WN LAW LNIF®R+MATI®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
comrgenling work or recording our Notice of Commenceme
Signa re of Owner/Less /Contractor as Agent for Owner Sign re of Contractor/Lice a Holder
STATE OF FLORIDA �' \ /I ST TE OF FLORID
COUNTY OF COUNTY OFC�JLC_ ;�
The for oing instrument was acknowledg d efore me The for oing instruent wals acknowledg d efore me
this day of 20y this y of 20 y
(Name of person acknowledging) (Name of person acknowledging)
1
(Signature of -S ate of Florida) (Signature - t y Public-State of Florida )
"I.PRY,
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Personally Kno _,�.• •`�=Ct�iPr���9cPlWNWicatio Personally u Identification
Type of Identi - ' • ' issl n-State of Florida YP P,. �t 011SCA 6� Y
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Bonded thn) gh Natio i 2019 1 ...'�a W� BonUeo hm'FXP/res
Commission No. - t YAssn. - Commission No.'s=�,ou Ma
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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