HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE IPFFO MOST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � i F Permit Number: l� �
_.... ..._.; .-. 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 I1NI'ROVEMENT LOCATION:
Address: 2-1,o 1 tiyf,11 S+ _Fof-- el,9V
Legal Description:
Property Tax ID#: I Z(a- 7C)a oSn,-_'.� <no Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DT I ED DE�SORPT ON ® WOR
fev Doors
MOM UCT O IN -OR+MA fON:
AUffitional work to be performed under trus permit-c ec a 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. x.
Cost of Construction: $�� Utilities: Sewer _Septic Building Height:'
OWNER/LE=SSEE: CONTRALTO
Name r-f—dnaS(__a auk�- ��2� Name:
Address: 6990 CSW C]tf i Company:
City: 6cm 4rave, State:l%G Address:
Zip Code:123L16Z Fax: City: State:
Phone No. SL/f- CIL-- S:L26 Zip Code: Fax:
E-Mail: Qm,&.2 2 Td 16 g . 0-a'rh Phone No
Fill in fee simple Title Holder on next page(if different E-Mai
from the Owner listed above) S e or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SMU'PPLEMENTAL C«®NSTRUCTION LIEN LAW I`BROMP A IN,
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 issiance 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 recordin - our N ice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF —S� ��� COUNTY OF
The f r oing instru en was acknowledg efore me The forgoing instrument was acknowledged before me
this ay of 20y this day of 20_ by
C� S= 4-re?-
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Votary Public-State of Florida (Signature of Notary Public-State of Florida )
Personall Kno OR Produced Identification Personally Known OR Produced Identification
Type o 'I eR I i Type of Identification
! tiPa P e, LA M HUFF Produced
Produ'ed o late of rids
E.: :•= Commission# FF 23473�0�^I Commission No. (Seal
Comm FOFF�01' My Comm FY iirae May 27,(§ '
°' Bonded through National Notary Assn.
J47't,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.