HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� 1 `'f� ( o
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:
Address: 1 1 2 a r/ t 5f
�. n
Legal Description:
Property Tax ID #: 4 I
P Y
C� ^ Lot No. 3_
Site Plan Name:
Block No.
Project Name: 1 C> r r f
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRWMN OF WORK:
ML;-?
h42apter
[CONSTRUCTION INFORMATION:
iti a workto a pe orme un ert
is permit - c ec a that apply:
Mechanical Gas Tank
_ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing
_ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: I S 1�0
Sq. Ft. of First Floor:
Cost of Construction: $ 51�> Se•CX
Utilities: _ Sewer _ Septic Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name and,'76
I vr'rk L h
Name: ' i c%I
Address: l La Carl ► Sl e-
LO
Company:
City: - _6 Sf r!tll�E
State:rL
Address: I 11� �
Wr
ZipCoder } CiS� Fax:
City:C -47 �'�' ' e _ Stat
Phone No. Szl'-fp
Zip Code: ?4Cl 9 -Ir% Fa '1-7 344 -to
E -Mail: —
Phone No.(-� "2:5) RD`-34-(a,S
Fill in fee simple Title Holder on next page
( if different
E-Mail:�� l
from the Owner listed above)
State or County License: Q
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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
commencin work or recordin o r Notice of Commencement.
Rev. 7/2014
G-.
Signature Owner/ Agent/ Lessee
Signature of Co or/License Holder
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The for ng instrupent was acknowledged before me
this L ay of tj 20 16; -,by
this ay of 20 1_4e by
(Name of perso knowledging)
(Name of person cnowledging )
(Signature of Notary Public- State of Florida )
(Signature of Notary Public- State of Florida)
Personally Known v/ OR Produ ed d t'
Personally Known ✓ OR Produced identification
Type of Identification
Y .
Type of Identificatio
" DEBORAH RUSSELL
•�,
• �;*
`� = State at Florida
Notar SPey
��`Y Oj'a
Commission No. -'+Q �,': Notary P45wa4pitate of Florida
Commission No. ;
s Co m�sslon #� FF 179630
':,, '• Expires Nov 30. 2018
- Commission # FF 179630
��; Nov 30. 2018
�� �.•• My Comm.
mm. Expires
REVIEWS
FR NT ZONING
SUPERVISOR
PLANS
VEGE
EA TURTLE
MANGROVE
COUNTER REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014