HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MUSI BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number:
l F 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:
PROPOSEDINPROV.EMENTLOCATI� Nr � ".c` �� �*� � ' f _2E
Address: S`Z !( ��Ly�� d � Q� �'li PI���� ` 3 2-
Legal
Legal Description:
Property Tax ID#: -3�10 Z' 60D Lot No. '^
Site Plan Name: Block No..
Project Name:
Setbacks Front Back: Right Side: Left Side:
rt ',.-4k +;. ' sr" i " sw
°D,ETAILED�DESKKCRIPTION F�WORK m ' `
x^ i` 'h #' t rt r Jt a �c' ":-{t TM M', at "'W? �" #� 6 �n �`�"r1 �
,'.-uE. 'sv�,. ' ,-
i3LAc-L1_ C1AAkob w�_ _ L,—l (I �
:,vim
lod9—s` &f,t�7^�h. �", y-.?: *'.F. itiN�"` '.0 ,.4 --' .�r,=,r�,'. � '!'u�'�, we4� +.t # �t,� cS K,��'g,1 ' '3.7 '-&^si �f } �u-
CONSTRUCTIQN INF®RMATION - k t
,.wtk �* ry'c ��.a trs3,s:. r= .Kazt, 5 n =, ,fi , nn.
W
Additional work to be pertormea under this permit--check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof fr-cw`:a
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1004'_ Utilities: —Sewer —Septic Building Height:
F: .s'
®1NN E�R/L'ESSEE _ r � ,�
s ; CONTRACTORz
r e ,stn a ,.:; e � ,44 �t__ .`;.. YEA 3
Name a2 Name: P-4AAiL_
Address: S ILvC 4 odk�C_ Company: %4- Q,,A-�-- rr-e-
City:,e\ A C-A-e_ State: L Address: /o S— CKs S
Zip Code: 345$Z Fax: City: e—. A c–K_ State.f- -
Phone No._ 'l`l QQ(o , 0(s7 U (, Zip Code:e3LN TC Z Fax:
E-Mail: Phone No 77 2- S
Fill in fee simple Title Holder on next page(if different E-Mail tei ,•a� ���( 1 °� C-
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commet is required.
SU.PPLEMENI" ►L C®NSTR`tJCTION LIEN LA1IV IN �®R11�ATIO'N':: mom
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 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. V you intend to obtain financing, consult with lender or an torney before
commencing work or recofding your Notice of Commencement.
Signature of dwnrLesse(ftontra.ctor as Agent for Owner Signature of Cc(nt&acUyfTLicehse Holder
y
STATE OF FLORIDA STATE OF FLORIDA l �-
COUNTY OF , k C COUNTY OF V - (213,2__�
The for oing instru nt cknowled a efore me The f ing instrur�r2t�t w s acknowledged efore me
this day of 21by this ay of �I 201ay
(Name of,person J
acknowle gi ) (Na e� f person acknowledging)
",J�
(Signature of Notary Publ -State of Florida) ignature of Nota ublic-State of Florida )
Personally hnow,p, „ OR RN6801c �cNl Fintifica n Personally Kn n t,._�. OR Produced Identification
Type of Ide t a - . Notar Publt -State of Florida Type of Ident is at
Produced '• " " Co mis on#FF 234730 Produced >°„ `° ANGELA M HUFF
My Comm. xpires ay 27,2019
sr7 .'^'`= r CommissCotPof 2347i3pda
Commissio No'����� Bonded throughNationa of Assn.
Commission No. =;r
y COMM. Aires Mav 27,2019
i' "" Bonded
LhnDtt9hNationa' :far
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014