HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLEI I.N,F'Ol MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I (-I Permit Number:
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:
Address: q 133 ()-np - P Vft l/ L
Lakes `V i c� 131or k C L o+- 21
Legal Description: �
Property Tax ID #: 33-34- 5D1 - D 123 000 - 1 Lot No. 2 1
Site Plan Name: n Block No. C
Project Name:
Setbacks Front Back: Right Side: Left Side:
E7(,CGC,'
Sc;m
T—
rp 17 I «nne n - ()P LL+nn
w Lt� 10 1(1 L) ho ri kef.
I INFORMATION:
)e pe orme un er t is permit -56EVail that app y:
✓Mechanical Gas Tank
_ Electric — Plumbing
Total Sq. Ft of Construction: I *uu
Cost of Construction: $ � Si) • 4 0
_ Gas Piping _ Shutters
Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
_ Windows/Doors
Roof
Building Height:
Name LT&XQ.A( I
Address: C1133 0r -1' -Putt- PL -
City: )�( + S+- /,()6e- State: L
Zip Code: 3 W186 Fax:
Phone No. 772- - 35G - 18 33
E -Mail: -
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Cra1q Co,►1,HP l
Company: 11 mfe-K A r Co Rf� i 410in't C
Address: S 7 I NI ll 1�IPXCCtji� OL- # 1,� -12 J
City: T()r+ St / LJ 6 Stater
Zip Code: 34186 Fax:
Phone No. 9D I - 14 GS
E -Mail: (�,wiaCAC 1t 9tvICAl COY"
State or County License: CAC I'63G
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION -
MORTGAGE COMPANY:
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
Not Applicable
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 yo r Notice of Commencement.
SignatureQf Owner/ Agent/ Lessee Signature of Coricet` or/License Holder
STATE OF FLORIDA
COUNTY OF
The for20ing instrument w4s acknowledged before me
thislday of 201�,- by
rt e (a i n �
(Name of person cnowledging j
(Signature of Notary Public- State of Florida )
Personally Known 1,,// OR ProrlucLd
Type of Iden
,• Y,P(js� OEBORi+t+ nGSSELL
+°4 = Notary Public to f Florida
Commission 9630
Commission
My C )mm. Expires Nov 30.2018
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
STATE OF FLORIDA
COUNTY OF f::3+•
Thefor ing instrument was acknowledged before me
this 1 `t ` 'day of 20Agby
6 t_C& L 4 ��n- -I-e.(
(Name of pe0o acknowledging )
(Signature of Notary Public- State of Florida
Personally Known ✓ OR Produced Identification
Type of Identification
41m
DEBORAH RUSSELL
Notar ) State of Florida
Commission No._ y !ICommission # FF 119630
,' My Comm. Expires Nov 30, 2018 _
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
J