HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ff��
Date: J� 'O� I Permit Number:
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Ill,Isal Id .
Building Permit Application DEC 2 9 2096
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 INRROEMENT LOCATI �u N�: , ��
.. uY�.>�.� enL•L�,ds�� �,:ear x. a. a.x ten.: . ,'SayatL.1+. ,.b: - .. is .._,.
Address: C� I S IF ! /J D e_/J e/e_e� �
Legal Description:
Property Tax ID#: m �ci1 70-^ 6-0 /-3- 0 C D_ L t Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�D1'AI�LE® DESCRIION F h 11/ORK x
J-7
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C®NS�TRUCTIO'N NO9MATION rt ,, _ 4
Add itiona workto a performed under this permit-c ec a that appy:
_Mechanical _Gas Tank _Gas Pipir"g = _ _Shutters _Windows/Doors
_-Electric _Plumbing —Sprinklers,' _Generator _Roof
Total Sq. Ft of Construction: /01 k' Sq. Ft.of First Floor:
Cost of Construction: $ f �'19D Utilities: _Sewer _Septic Building Height:
OW�NERM
Name i / [ Name: f
Address: ��� � e Company: /
City: 5 L StateP Address: "70SC 1741661 <f
Zip Code, �1 �� Fax: City: State:
Phone No. �4 95 5 -3-3 E) Zip Code: 491-q 9 a-3 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License C'-G C_ l S ® Ln 5 to
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPFLENifN' AI. C®NSTRUCTI®N LIEN LAW UNF®RMATI®N.:
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 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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owne %, ature of Contractor icense Holder
-"^wpp•__ rr '=may. �,o
STATE OF FLORIDA ST, TE OF FLORIDA
COUNTY OFY-1-14a m CC,JNTY OF m
The forgoing instrum t was acknowledged before me g forgoing instru ent was acknowledged befor rm67 c
this day of 20� by z i day of 20�lv by o
c s� �
lfl I C z-- n i I C k:m- �A
(Name of person acknowledging) a (NA a of person acknowledging)
(Signature of Nov
o a Public-State of Florida ) U (Signature of Notary blic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati Type of Idi-n rf' at'on /�.
Produced t/ `�" Produced___T
01/y--
Commission No. (Seal) Commission N (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014