HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO M ST B OMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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(7POSED JNPR01lEME1`T,LOCATIQN
Legal Description:
wlvaK Tax ID#: 2 'Z(�- LQo - C�(�3�- �- Lot No. -4-C5
Site Plan Name: Block No._
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION Ot=t1N0RK
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CONSTRUCTIQN INFORMATION
Acicl
itiona wor to a pe orme under this permit-check all that appy:
—Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
O(E'lectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cof Construction: j�-�r-�. Utilities: _Sewer _Septic Building Height:
aWNER%LESSEE ..m :: : CONTRACTOR S : = kali
N,�ame
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Address: s Pjny:4 IctAl A� EL.-C A�
City: State: T� Address:
Zip Code Fax: c�� City: State-
Phone No. �` 6Zip Code: :--q%/2- Fax: -,n7_- LLRI-LICKz�1
E-Mail: Phone
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License( `LOA?)
Lof construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INORIVIATIQN
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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.
igna- of Owner/Lessee/Contractor as Agent for Owner oSign -erof Contractor/License Holder
STATE OF FLORIDA L ` STATE OF FLORIDA
COUNTY OF ``J ' COUNTY OF
The fGKgoing inst ent w s acknowledge efore me The for oing instru ent w a cnowledg d efore me
thisay of 20 by thi day of - 20by
(Name of person acknowledging) (Name of person acknowledging)
Ij
9/-Ag— /� ( 0
CiK40. a
(Signature of No a y Public-State of Florida (Signa ° r ub i - Flo da)
AN
otary p GEtA M yUF
sonall Known OR Produced Identification Pers I afi�'r FF o , CPr4dNcFd Ident ication
Type o „ ANGELA M HUFF Produced '� ondr, o I'V res of'3473pFlorida
Produce :'�PR"P"e.%
UVtie-Slate of Florida "' a,.°�alNotar• 19
commission#FF 2$473 Y.4
Commiss r;; l'o�-_ m Esni�es May 3; Commission Commission No. u• al)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014