HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. I 1Permit Number: 1(g,11—
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:
PROP•SED INP'ROVEMENT L(J ATION: //
Address: OCA /G �
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: /b Left Side:
D A [DOMM • @V W• R .
y� Q � -Co >< �o ewe
CQ �T UCT ON FOR 10
AWffional work to be pe orme un er t spermit-cfiecRa tat 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:$ ��� Utilities: - —Sewer _Septic Building Height:
� N R L S� CON RA OR.
Name C' v 6t Name: vt J w i e2y
Address: �,4 -gP Company: S'w ; 22,E Co ti S Y- Ile �rd�
City: rf /P/erc State: F�- Address: e2 S
Zip Code: . Fax: City: 7�, Sf L U c ,n State: l,:-L
Phone No. X7 2 yG Zip Code: 3 Y`9-F- Z Fax:
E-mail: I) 12 NI a rV 1461 o Ai�7 Phone No 7 ;7 2 3 5 9 5 O 9 Z
Fill in fee simple Title Holder on next page(if different E-Mail S-Fun 44 wq h 396 (2 GrnQ .
from the Owner listed above) State or County License 4f G
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CO'NSTRU'CTION LI' N 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 inspe tl . If you intend to obtain financing, consult with len¢ r/br an attorney before
commencing work' , cording our Notice of Commencement.
zv
Signature of(�Gvne /Lessee/Contractor as Agent for Owner Sign ature,o ntract r/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF G COUNTY OF �
The forgoing instrum +fit a ,ackn wledged before me The oing instru t was acknowledged efore me
this day of / 20 by this aay of 20, by
(Name 6f p rson ack ow edging (Nam p son acknowledging)
' 1NA I L�J
/r
(Signatur i (Signature o Not ' Public-State o Florida)
O(P{yY 1 PUe,•� ,
Personally • =
Notary Public State of Florida
y &WAwgedrlommica 'on Personal K(Lov��, r duced Identification
Type of Ide m Expires May 27.2019 Type of Tel n A M HUFF
Produced o F ; ` My �t National Notary Assn Produced='_'« - Notary
ornmission orida
t. of«o?r` My Comm. '#FF 2347
Commission No. (Seal) Commisstotit�1°o. ' P ExPires May 27 e
' °U�ional Notar 19
Y Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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