HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE, NFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'
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Date: �1 45 I� Permit Number:
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:
PROPOSED INPROUEMENT LQCATION: _I
Address: C �, 0izrS� �S
Legal Description:
Property Tax ID#: elo 9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
+DETAILED DE�SCRI TIO OF WOR / OCJ--/ /
416ttid CIA) `VO �A s �1��✓ �c��RL(� [7�/�
CONSTRUCTION IN O MAT(ON:
Additional work to a peffo-rmed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
( -luectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ ���1'd Utilities: —Sewer —Septic Building Height:
NOT. /LESSEE. CONTRACTOR:
Name Name: ,fiL15 _ jtvs
Address:S4-��\ sx CeLir1-- .0c: Company- ✓vt �� Z6ca .
City:' State:State:� Address: 0 � //�9 1 _44 of C
Zip Code: Fax: City: State:rc t
Zip Code: �
Phone No-<. �/�'�y Fax:
E-Mail: o Phone No 7-72- 28 - _77V Z
Fill in fee simple Title Holder on next page (if different E-Maileo&;S Q,✓ 2�4irc r7
from the Owner listed above) State or County License - G/3067,2yz_
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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5�U'P'P'LEMENTP►L O NSTRQ TIO LLEN 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing workpr recording our Notice of Commenceme t.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA 'l- � STATE OF FLORIDA
COUNTY OF � COUNTY OF
The forgoing instrun n was acknowledged before me The for oing instru t was acknowledg d before me
this�day of 20IG by this day of 20 by
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( me of person acknowledging) (Name of person acknowle _.ng)
tvNjl 'n I — - an�ag -,�h
(Signature of Nary Public-State of F o d (Signature of No ry Public-State of lorida )
Personally Known OR Pr duced Identification Personally Kno O,Produced Identification
Type of Identification Type of Identi Pe(� ANGELA
Produced � " M HUFF
Prod uc _
• p ate of Florida_
.•aY P� •� N,o '\oPc, ,Commission#F(�
Commtss°tP °A� Notary Public-State of FI°�ea Commission•Io.'-:POPE°?••� My Comrp,Expires Mgy 27WO
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FF 23473 onded throw
.oe My Comm.Expires May 27,2010 9h NationalNotarygssn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION_ SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW , REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014