HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: OGS n Permit Number: 6-1 0�e
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:
PRpPUSED IN-FROVEMENT LOCATIQN. : h °Y
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Address: SoZ O'� Sj r4S e� j3 Jo f-. 17t 6rcz .Gr p 3`( ` g?—
Legal Description: SrickAr-) RC,)e-,z --&OA-e-s CSN ik ly7 amu{ 53. i- O+ 10
�An a-S C a2 3�.I�'- 4.3Q- 3- 28'8'0)
Property Tax ID#: � �l� a' �B�- �� �� " �� Lot No. �y
Site Plan Name: Block No. S.3
Project Name: N elrJG-ei
Setbacks Front 5 Back: Right Side: 7 Left Side. i
DETAILED DESCRIPTION OF WURIon
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e,� i2 FX��fk�n7�, ��Nc r TesVaA-1 N)" 1%i2n� O2J
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CQNSTRUCTIC►N INFORMATION `
,
Itiona ivorktobepertormed under this 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:
Cost of Construction: $_ Ay-EDO •� Utilities: —Sewer _Septic Building Height:
01NNER/LESSEE.tCONTRACTOR 'n
Y 4�
Name M1,00 -Cart A.� F_ �, ��u Name:
Address: Sao'-( Ste„ ��`'o Company:
City: r-y State: - Address:
Zip Code: Fax: City: State:
Phone No. 630 3 Zip Code: Fax: /
E-Mail: 0 R44-, Nit Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
^from the Owner listed above) St or County License
J[Lvalue of construction is 2500 or more,a RECORDED Notice of C mmencement is required.
SU,PRLEMENTAL CQNSTRUCTIC}N LIEN LAW INFORMATIO,
N
DESIGN ER/ENGI
PP MORTGAGE COMPANY: _N�
NEER: _Not Applicable of 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.
ature of Owner/Lessee_/Oontractor as for Owner Signature of Contractor/License Holder
STATE OF FLORIDA c // STATE OF FLORIDA
COUNTY OF )''� L�l�!✓�e� COUNTY OF
The f oing instrum t R <nowledg efore me The forgoing instrument was acknowledged before me
this day of 20� by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Nory ublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known,, r�r����,— tion Personally Known OR Produced Identification
Type of Identifi,, A M HUFF Type of Identification
Produced' e` - r;N-p ate of Florida Produced
• Comm ss on 4730
`o&; My Comm.Expires May 7019
lN
Commission-N.�F P,•' Natlonasn. Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.