HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFR MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / v�
Date: Permit Number:
RECEIVED
Building Permit Applicatior�EP 201
Planning and Development Services 6
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:
PRC7FC}SEQ � 3U 11 EN �I C}CA,
Address: 1
..0-7 !L <2 Yn fS
Legal Description:
Property Tax ID#: (V b �.� 95/- :5 "' 0�37 ��� " fo Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AII.E[} [ R�PT(CI }�WC}RK R °F' % Ok
,
\ ISa
7
a kS
All
CC3TRUCT�O�(NFOR�1!) T(CIN \ �� M
Additional work to be pertormed under this permit Check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: = Sq. Ft.of First Floor:
Cost of Construction: $ o�Jr Utilities: —Sewer —Septic Building Height:
OSIER/LES . �, or
CON
RACTORF `
. .
Name Name:
Address: )(E�>-7 �� C'�1Y� u�0 'S-C Company:
City:P�Q_ <_zt3C State:E Address:
Zip Code: Fax: City: State:
Phone No. •7 7 4-S 7 (2D Zip Code: Fax:
E-Mail:\,,r• I t-), 45?,L_AN0t rri-Q,I_x CboWhone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU '�P�EMENTki�CNS�RUCTIN t� EN LAVkI I�IORMA7t€�N•
DESIGN ER/EN6fN—ER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: R . -3 , "V,/-/��L�✓�L, Name:
Address: I eD—i <3 Q�- 3ft, '::,:pT Address:
City: Rw_-r 15-,t State: cif City: State:
Zip: gS2 Phone 1,,9-7 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name. 2_ ) Name:
Address: i (=�)•7 ',�:5 c--= Address:
City: !De ig;< �_L_p C=)tF— City:
Zip: :�g !95 4 Phone: ?7� -�CcCF L�f�7C� 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.
ina of Owner/Lessee/Contract r as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORI � '* ATE OF FLORIDA
COUNTY OF UNTY OF
The forizoing instrument was acknowledgeq before me a forgoing instrument was acknowledged before me
this day of 20/U-by a x80 gt s day of 20_ by
. r
Er
(Name of person acknowledging) � me of person acknowledging)
� N f11
(Signature of N ry Public-State of Florida (Signature of Notary Public-State of Florida)
Personally Kno OR Produced Identification Personally Known OR Produced Identification
Type of Identifica n / Type of Identification
Produced (�'!''• Produced
Commission o. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. /2014