HomeMy WebLinkAboutpermit aplication 2 All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ++.
Date: Permit Number: ( �D�
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�OP�SED fNPR.01/�MENTLOCATI �^!Nc
Address: 76115-6 &A C_e?j' 9UA) �o��� 54 • �<C�LieT �L Legal Description:.Description: u n i^i e>4,Grp L'
Property Tax ID#: 3yl �d� (dg �� Lot No,
Site Plan Name: Com' re 1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA�I�LED D.=�S:CR�I�PTLO :` 0"F WOR
r .
(Co=@N STRUCTION LN'FORMATION;
Additional work 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: Sq. Ft. of First Floor:
Cost of Construction: $ 100. Utilities: —Sewer —Septic. Building Height:
Name_ CJ r �� i Name: ��u1 4- �✓
Address:- t_0 . ,r �•� - Company: e v r
City: a5 .7 F L state-t Address:
Zip Coder Fax: // City: -State:�L
Phone No. (' o - (✓��P��b b��J S - Zip Code: a222 Fax: /-3
E-M a i 1:
E-Mail: f me vv� -✓ ,CphoneNo 76r.1
Fill in fe simp a Title Holder on next page( if diff ent E-Mail s�e
from the Owner listed above) State or coun." License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
N �'PLEMENTAL CO-0 MI CJCTI'ON LIEN LAW INF®RjMATION,:
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
commencinR work or recording our Notice of Commencement.
Signa ure of Owner/Lesseettontractor as Agent for Owner Signatti of ifforftractor/L!oKse Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF Ch-_lyse
The forgoing instrument was acknowledged before me The forgoing instrument w s acknowledged before me
this day.of �p�p ,20-& by this day of 20\(, by
Q�k
C-ctQ0f c D__
(Name of person acknowledge (Name of person acknowledging)
gnature of Notary Pu ic-State of Florida ) 0eature of Nptary Public-Sta of F orida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. _ ;" M -Notary p a� Ej
Commission No. ""'�•�, W'P�99 HNA INGRAM _ Y 46� Mate of Florida
a°� ,`�•� Notary Public-State of Florida. NqJ o MY Comm.Expires Dec 20,2018
=•« : _M 'Comm.Ex fires Dec 20 018 '%F oa.•
Commission
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Commission#FF-177249 "' onded through Na ional No-tar s ,
REVIEWS FR T°''°����LOft Mthroug t8UAE1ftVJ6(slfi, PLANS VEGETATION S A.
COUNT REVIEW. REVIEW ' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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