HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: a- d �3
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 I/
PERMIT APPLICATION FOR: • C�,,l, s �� rz Pt
PR®P®SSE® IN-P1R,0��/EM�ENT LOC�Al'IUN�� t
Legal Description: ) S"► � � .-- � ��
Property Tax ID 13d�� ��1-�ddO - ��0 ' O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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C®.NSTR',IJCTI'ON IN"FOR�I�/I�ATI®N
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Additionalwork to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator ✓Roof
Total Sq. Ft of Construction: Zdbn Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height: 0
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OWNER �LESSFE� ��� ;�' CONTRACT R= , a .
� a � a� reg
r u,pam.. ,;_�. . .fit � .F�,°��• �� �.� �
Name .� �e:�.,:
�o!,i�{�St4Ei .
Address: ! D �Iti e, t1�i:i, ;Gatn panV:11'U i :r C.
aN!•i7R?
City: State rC -;,Add,r. 5
Zip Code: ? ��.5� Fax: ti`"s t,L v ~n' State:
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• ' State:
Phone No. Zip Code: KFax:77�� ; 25 tel
E-Mail: y Phone No WZ �.��9
Fill in fee simple Title Holder on next page (if different E-Mail Z
from the Owner listed above) State or County License GLGfbC_::'7.3I
2.
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
St1�pPLE11�ENT"A1 CQNS1"FtIJ�TION L�E��ILAW 1NFORMA`�T'I�t��N::`
DESIGNER/ENGINEER: ii Applicable MORTGAGE COMPANY: _.,,,Pd"ot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: 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 mayrestrict 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, ['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
commirricing work or recording our Notice of Commencement.
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Signat of Owner/Lessee/Agent Signature of ntractor/License Holder
STATE OF FLORID r STATE OF FLORIDA
COUNTY OF COUNTY OF '(�.1(,C•�
The oxgoing inst ment wasiacknowl edged,before me The fprgoing instNmenn�s knowledged,before me
this Om day of.7-C � 2011 by this{7�� day of QCT , 20by
(Name o person acknowledging) (Name of person acknowledging)
Signatur o N taQ ry Public-St f Florida) (S_nature of Not ry Public-State 8T-ii a )
Pers own\\1 O duEed lien"tificatiom"` ly. nown OR Produced Identification.
Type of Identification Type of Identification
Produced v — — d_
tl
JAIME CAM
Commission,No.w f)Notarypumle-Stats 1Ell sion No.W (Seal)
z •= My cow.Espins du 1.2018
CwAssion®FF 111445
Ma�rl�air tasy lWn. .
REVIEWS FRONT Z VEGETATION SEATURTLE MANGROVE
COUNTERw REVIEW- ' REVIEW REVIEW REVIEW (REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014