HomeMy WebLinkAboutBuilding Permit Application All APPLiCA LE INO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: Permit Number.
-- Building Permit``Appiication
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue,Fort Pierce Ft 34982/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential v
PERMIT APPLICATION FOR: b cv,
PRQ,P�SEQ N„ :PR EM'ANT LL�CATION:
Address: e.. l'" a
Xa-
Legal Description: i K
Property Tax ID#: t") cam+ ccol Lot No.
Site Plan Name: Block No.
Project Name:
x
Setbacks Front BFck---- . Right Side: Left Left Side•
D T ED D SSC iT QN O OR+
C�ONSTRUWOMEN,INRMATI'UN:
Additional work to be performed under this permit-check all that 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:
Cost of Construction:$ /7�V U_ Utilities: —Sewer —Septic Building Height:
t WNER/i. S E• 1a3ITRAC OR:
Name ''l - 1 Name: t >
A d d r e s, ti-( tr Company LUC t!y't
City: 12 1 , State-Al, Address S I-
Zip Coder Fax: City: -C I-K.c State:
Phone No. - 0 Zip Code: Fax:
E-Mail: 0 Phone No -G171
\ Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
f value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
EMENTAL MANSTRAMM ION I LIEN Q\,YJ INFORMATION:
DESIGNER/EN INEE Not Applicable MORTGAGE COMPANY: _Not Applicable
r
Name: 3 Name:
Address:� Address:
City: t Stater 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 wi•II authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules;.bylaws'dr'and covenants that may,restrict or prohibit such
structure. Please consult with your Home Owners Association and review-your deed for any'restricticins which may.apply.
In consideration of the granting of this requested perDit, I do.,herby agree tht,,l hill;i:n all res•pectj,+>pei'form.l#ig work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County`Aniendments.
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.
igrraa tuF06ffOWner,Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA i_ L � STATE COUNTYOF
OF FLORIDA
COUNTY OF .A
The tKaoing instrLAERent was acknowledged before me The forgoing instrument was ac owledged before me
this-LI day of y this day of 20_ by
bo� -e_> V,, k—�� A
(Name of person acknowle ging) /J (Name of person ack wledging)
(Signature of Notaryublic-State of Florida) (Signature of otary Public-State of Florida)
Personally Known OR Produced Identification Personally nown OR Produced Identification
Type of Identi ' t'on Type of Id ntification
Produced _ Produce
�•1PR,Pia... ANGELA M,HUF&F-.'`
Commission No. '2�* �` Notary Pulili �te of Florida Comm' Sion No. (Seal):"
Comm(ssion# FF 234730
Comm.•Ex i
"����•`
Bi inoed through Nation Notar Assn: n
REVIEWS FRON SORP NS VEGETATION SEA TURTLE ;MANGROVE
COUNTER , REVIEW- •REVIEW R IEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev.7/2014