HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INF MUT BEC91,11PLETED FOR APPLICATION TO BE ACCEPTED
Date: _
C4011 NI lr
F L /7 R 1 p R
grommommommimmo 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
Permit Number:
Ic1c —o;�
PERMIT APPLICATION FOR:
�'PRC}POSED=IN'PRO,V
Address: /off 0 3 Lull: h
Legal Description:
Qui
til/ JLorl- f`ce
Property Tax ID #: CSS -Tsc.3 1—'1 8
Site Plan Name:
Project Name:
Setbacks Front
k4'
LE,D.
Back:
iriook u0
CONSTR CT ON IN�FORNIATI:.
Additional work to be pertormed under this permit - check all that apply:
Right Side:
Left Side:
Residential
Lot No.
Block No.
_Mechanical
Electric
Gas Tank
_ Gas Piping
✓Plumbing _Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ ,,;(5)0 CO
w EkR, 12E -
Shutters
Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Name DooclaS
Address: 11o3 c, -/X Li I
City: k- P1•LCC. State: f I
Zip Code: 624 39gga Fax:
Phone No. L/13 -39-9- /68-Y Caw
*3 -L1961 75a/
E -Mail: C'! rSg a p aoI Lo
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: 1PCtu
Company:
Address:
City: fbC\-- 9terc..&
Zip Code:
Windows/Doors
Roof
Building Height:
Fax:
) 011.0 .1\ -enc.,
State: F I
Phone No -77 Vcfic-4-oa -7%a-s7
E -Mail £2 , V12f-
State or ounty License (B CD 3 FI S
6133
If value of construction is 2500 or more, a RECORDED Notice of Com
ncement is required.
MVP
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip:
Phone:
Not Applicable
State:
Not Applicable
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. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
q 0 i— `
Signature of O9mdr/ Lessee/Contracto\as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA S1/4STATE OF FLORIDA
COUNTY OF COUNTY OF
The � r oing instr m nt was acknowledg d before me The forgoing instrument was acknowledged before me
this Iday of P (' , 20 j by this day of , 20 by
S\ke_k\ \ \ Z€-\ \)
(Name of person acknowledging)
(Signature of N
Personally Known
Type of Iden
Produced
Public -State of Florida )
OR Produced Identification
Commission.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
iev. 7/2014
UFF
S. Notary Public - State of Florida
;;,,; • Commission # F1h0
;,"0"..0".°:� My Comm. Expires May 27, 2019
" i ,, t`'', Bonded throu
h Nation
FRONT
COUNTER
ZONING SUPERVISOR
REVIEW REVIEW
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known
Type of Identification
Produced
OR Produced Identification
Commission No. (Seal)
PLANS VEGETATION
REVIEW REVIEW
SEA TURTLE MANGROVE
REVIEW REVIEW