HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IN O(M STB OMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L , Permit Number:
4- R-
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:
PROPOSED IMPROVEMENT LOCATION
Address: ®00 ` e 44)"'F74
Legal Description: Vi Q1 C2 :W3 0,3 05 DDO 0
Property Tax ID#: a q)to To,3 0,306 0,0 ® Lot No.
Site Plan Name: Pi CICer-" M Block No.
Project Name: 'PC.k-
Setbacks Front Back: Right Side: Left Side:
DEl'AILED DESCRIPTION,OF WORK
Ne w. 9ti v�4' t9 P
CC NSTRUCTIC"41NFORNlATION
Additional work to be performeun er t_is permit-check all that 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:
-cam
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
OW ER CONTRACTOR: F. ?,
Name i Cie �tih Ccs- f' Name: Pt�iL Obi^
Address: Company: is"O' boor—
City: State:EL Address: D`79�r� 1�L` l D� AU-P,
Zip Code: Fax: City: 01C'eeA0b•e 'e_ Stater
Phone No. aZ - y10 q— �l � Zip Code: '-3 y(2 7 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License .S f j
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
FORMATION:
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INE,
DESIGNER/ENGINEER: Not Applicable t _
_ le 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
commencing work or recording our Notice of Commencement.
�V
Signature of O /Lessee/Contractor as Agent for Owner Signature ontractor/License Holder
1
STATE OF FLORIDA ( * STATE OF FLORIDA
COUNTY OF �,o _ COUNTY OF L
The f ging instr mer�i as acknowledg d efore me The f ping instr t was acknowledg efore me
this en
day of 20by this day of 20by
(Name of p son acknowledging) (Name of p son acknowledging)
(Signature of Nota r blic-State of Florida) (Signature of orau lic-State of Florida- - - - - - - - - ?
)
Perso y ,nrayyn ication Personally Known O Produced Identification
�' Type of Ide tiff
Type t y Pub is S e of Florida produced
Produ '.`=
0
iNf Q` �,' `t� P`'',
My Comm.Expires May 27,701 io a, ANGELA M HU
�4•`� * Notar �l
CommtssioYt� d Bonded through n;,nnna (Seal) Commissio _. YPublic.State �lo1(da
F10��` Commission 4,MY Comm.Ex ire AA
'FF 234730 .
e through National Notary rs
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION S `TURTLE-r• MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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