HomeMy WebLinkAboutBuilding Permit Application All APPLICABLf INFO 14UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �.
Date: Permit Number: U
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 L®CAT10N:
Address: ` A
—31 \ J�7
Legal Description: G � l/ Yll.RS e Q �
PlAt I&W I Ige, 3 i
Property Tax I D#: ��l 8l�� CDU Jr-` `b� — 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
0 T 14LED Df�SCRaIPTION ®F VU�ORaK•
C' rU G, e
�21A10 -7
911 05AAF
CONSTRUCTION I`N'FO MATION:
Additional wor to b&pertormed ' un er this permit-7check all tat appy:
Mechanical -Gas Tank) '_Gas Piping ~" Shutters. :, ' Wi'ndow' s/Do
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 9.
Cost of Construction:$ addle Utilities: —Sewer —Septic Building Height:
®U-1/NER LE�S�-SEE: ' COON RACTO'R:
Name 7Z;,40 Name: ori
Address ..! Compapy:
City: ( �/se s State:_27Y Address.: 3403 e�S
Zip Code-.J City: Stater
Phone No. J��o��� " 777 Zip Code: �Q�Jr� Fax:
E-Mail: Phone No :22?—,677---!V73
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License e22722,
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJPPtEMENTAL JX�N FEE 00011
INFARN 11
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: A Name: I —
Address: Address: 1114
City: JJ I State: City: /V (,/ J 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 your Notice of Commencement. ----------
Signature(�300w Owner/. Psee/Contr c or as Agent for Owner Signature of Contractor/LicerfsFe Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was a�cnowledgecl before me
this 'LO day of 20 th I
Ag by s day of <too le✓ . 20 /6 by
74 L
3/mm IZ.G III
(Name of person aKnowledgidO (Name of person acknowledging)
OAAA��
(Signature of Notary Public-State of Florida (Signature of Notary Public-State of Florida
Personally Known- OR Produced Identification Personally Known X OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. Commission No.
NAAN "'y
W'y
C-WNISSiGN 0 EE°. 872314
#1�*72314
01 .'I�ct, .'111'*?N#EE*72314
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EXHAES:Fabibary 7,2017
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REVIEWS 71- /0XIM P ERVISOR PLANS 'VEG N_ ar-M I UM I Lt GROVE
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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RECEIVED
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COMPLETED
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