HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rr��
Date: 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:
PR ® f NEC�AOPSD1QN5,17 f ~
Address: C_n
Legal Description: _LcT 11 ! l /� - �{ 'SA..Ua.40-k
Property Tax ID#: -70a Lot No.
Site Plan Name:. Block No.
Project Name:
Setbacks Front $ Back: /$ Right Side: Left Side:
�QETAILED DESCRIPTION OF WK -�; N-1.0-11"; i s
R e-m a tl c >;s�i�-T: ti C an e, ,cp Re�z' a 0-,,Z6 e e lc,. e CJ c G
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CONSTR',UC"TIRQIv INFORI�/IAT{`O`N:
A itiona wor to a per orme
under this permit check a that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: i 9 io Sq. Ft. of First Floor:
Cost of Construction:$ V d Utilities: —Sewer —Septic Building Height:
OU1lNERY�L�LESSEE: CON RAC°T®�R:
t r
Name_ re--o c 1VI QfiTe-Y-Y) Name:Abo-.xi, cz-11 2.4 t,)i,g-o t,JSlc
Address: ` 5( 7 Le,�_ 'i-e a c(, Company: Act -,Qm�r� �-- bd�� If 91"adele
City:_ ria rT S L, L u 6 e State:KL, Address: 0 a f SAE' . 8&r-k-5 ol-w- 131!/d,
Zip Code:3 qSv Z' Fax: City: r1, ST, Lroci L State:H L,
Phone No.l-t%a7 =-5 96 - / 7 7 Zip Code:3446-2- Fax:
E-Mail: Phone No - 34_9 - 7$" e4
Fill in fee simple Title Holder on next page(if different `E-Mail
from the Owner listed above) State or County License C PCcs 16 a 56
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
� PLANNING & DEVELOPMENT SERVICES DEPARTMENT
KJUT-RBuilding&Code Regulations Division
2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I,the undersigned, am the owner of the following described property,
Rcr- o b �� ��s/7 �ec.�Qry e� �� lord S 4 �e �L
(Parcel I&ILegal description/Address) t� '
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number ' I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St.Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my, property which will not adversely affect the immediate
community.
Property Owner Name(Please Print)
P perty Owner Signature Date
STATE OF FLORIDA,COUNTY OF • Lo&t e,
ACKNOWLEDGED BEFORE THI DAY OF IV 0V&+'"L 1- 20 1b
BY WHO IS PERSONALLY KNOWN TOME L—)OR WHO HAS
PRODUJ� AS IDENTIFICATION.
SI0&4
C� OFOTARY PUBLIC TYPE OR PRINT NOTARY
(/O�/COMMISSION NUMBER
ROSERTHUGHE& .
;.. MY COMMISSION#FF 950030
w EXPIRES:January 12,2020
Bonded Thru Notary Public Underwriters
SLCPDSD Revised 04/11/2011
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UPS— LENT L C NSTR CTI®N 0I,E°N Li4W INFORII/IA�I N:
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 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 tb 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.
J
01
Signature of Ow r/Lessee/Contractor as Agent for Owner Signature of Contract&rKicense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �,�;LrA Q . COUNTY OF sza-N'X�
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this E day of P50 20 (p by this��day of 20-& by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Rate of Florida) (Signature o Notary Public-State AFIorida )
Personally Known OR Produced Identification Personally Known OR Produced Identification "Na
Type of Identification Type of Identification
Produced Produced
„( ASHAf� ® IGRAM .
Commission No. (Seal) Commission No.
•6 1\#
NotaryPubli - a e of Flori
v; My Comm.Expires Dec 2r'. �018
_ "'-
�� LAS 3 �i�d' f F4�4�` om
e� blic S t of Florida. ati� 'dotary Assn.
REVIEWS FRC+i •.Z("MtP
�` , Expi e c�9VlgPLANS VEGET\QTIb'�!'"'� S MAf�tG-f E
COUN�E:. .' gyp' ion#F?�� REVIEW REVIEV1V REVIEW r REVIEW
DATE Bonded through tional a ary
RECEIVED
DATE
COMPLETED
ev.