HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 1
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR®P- ED 1NPROMEMENT LOCATIO' /
Address: ® � n,.,J/� i' ,�S /�
Legal Description: 7� &_ C.ls� L/�IT �EJ< �CJ�
Property Tax ID#: U� ! (7 v Ooco— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DfT'AILED D£�SGRdP I0'N ® W0 + .
om 61700 D� !,�
W Al-It/ O
CONSTRU'CTIO'N NFOR61 MATIONSM,
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: $ Utilities: _Sewer _Septic Building Height:
OWNER/LE�S`�SEE: CONTRALTO
Name J Name:
Address: ID 1W Company: C Ezi
�
City: 7 XdE/ State:_ Address:_2
�_
Zip Code: b Fax: City. State:.
Phone No. 7?12,' �� Zip Code: � Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page if different E-Mail r _
from the Owner listed above) State or County License 1 –S
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSI`R�UCTION LIEN LAW IN�FORMATI®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 thepermit 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 of Owner/Lessee/Contract r as nt for Owner Signature o ntra icense Ho ,
STATE OF FLORIDA STATE OF FLORIDA ,
COUNTY OF �`�G� COUNTY OFSLGI
The f oing instru ent was acknowledg d efore me The oing instr ent was acknowledged before me
this day of 20by this day of 201Q by
Gc oJi 010on cexx::110]
(Name of person acknowledging) (Name of person acknowledging)
Q���v�� 0�", A 6
(Signature of Not r Public-State of Florida) (Signature of Notary P lic :State of Florida)
Personally Known OR Produced Identification, Personally Kno n OR Produced Identification ✓/
Type of Idem' ' Type of Identifi a i D
N M HUFF "av '
Produced "YP' �� LA Produced �P �e'
o aryu i - to of Florida . *° Notarypubllc St-
HUFF
Commission# E 223 730 '�� ' Co orida
Commissions a�9. 4ea. EX,,;res M`i9 ,201a Commission 10:9,,oF o`;: ommission#F3q�30
? i mm.Expires Ma
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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.
7/2014