HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2� Permit Number: \C Oq
a
RECEI`,'rD SEP 2 3 7316
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: -
PROPQSED INPRC!VEMENT LOCATION:
Address: a o d 3 YS5
Legal Description:
Property TaxID#: �3�� '" ��5`�\a�vC�C'�4'3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WOR
K
, e
CONSTRUCTION INFORMATION
Additional work to be pertormed under this permit–check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _�-Piumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ A DJ Utilities: —Sewer _Septic Building Height:
01NNERjLfS5EE CO.NTRACTC►R s
Name o5C . :n ` ;� Name. W.r: �• `� oto
Address: << �.. � �: u:�: Company:
City: {� Q i' sc-� State:_ Address: BID( r�• ,e«e_ P U cY/
Zip Code: 3( b &Z Fax:- City: State: V
Phone No. -77A -5/110-22 Zip Code: YrA�c5� Fax:
E-Mail:• Phone No ��- 3, ,-�`- Z
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License CEC
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPRLEIUIENTAL°CONST RUCTION LIEN'LAVI/;INfORIVIATIQw
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/C tra or as Agent for Owner Signature f Contractor/Li se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY 0 r . }I.:Jc to COUNTY OF Sir Lt1c�t�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this'D_3 day of S� Q-�+ 20� a3 by this day of S-Q-, 20_JSj by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu&k--State of Florida) (Signature of Nota ublic-State of Florida )
Personally Known OR Pro patio Personally Known OR Produced Identification
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Type of Ident ation, DEhN�tAARI- p22023 Type of Identification
Produced M�ss1oR A6,2020 Produced 1—�pL
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4�1itES:De rtoUnderots „«�..,, pEANNA IE GIVENS .0
pobl Dr,022023
Commission No. ded "No� Commission No. '=1<o CpMMISS►oN� ��D20
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�''�oii°Q•• Bonded
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014