HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. �0 ��rit Number: 1 0•� 'O�q
APR 0
Building Permit Application '
Planning and Development Services
Building.and Code Regulation Division
-2300 Virginia Avenue,Fort Pierce FE34982---
Phone:
-Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential _,
PERMIT APPLICATION FOR:
Address: i% d -P1Z _S r cl-
Legal Description: Le-'w ocid U n 1 la ^ a 11C IU 3 Lo f /
NAP IZs
Property Tax ID.#: —01<5e? —000— Lot No.
Site Plan Name: P Lv )' Block No.
Project Name: ci�c,>i (� Cu rhe -
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping -Shutters _Windows/Doors: .a'
_Electric _Plumbing Sprinklers _Generator _Roof Pitch
Total Sq.Ft of Construction: • Sq. R.of First Floor:
Cost of Construction:$ `7l 0(_) Utilities: -Sewer _Septic Building Height:
Nameeyoi2 w Name' AJC in.�
Address: 7d ��0/J-AIL' JZ Company:'. .,:..
/�/Lc- � , �l `
City:��' State:_ Address:' L7 '
Zip Code: 3 9S-1 Fax: City: % PrzC State:
Phone N 7 Z 5"/ Zip Code: �•° 9 S-) Fa
E-Mail:_ •encri-�Vj1-H-0y 0/P % "A Phone No 7 7.11
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License �-
if value of construction is 2500 or more,a RECORDED Notice of commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not}App'
licable
Name: • Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _,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
commencin r or r ding your Notice of Commencement.
nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S - L o c i COUNTY OF
The forgoing instrxment was•acknowledged before me The forgoing Instrument was acknowledged before me
this Co day of 20JI by this day of .20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu ic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type"of Identification Type of identification
Produced 1.7 -----9 Produced
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M� T�IIS510N#Gp220 . Commission No. Seal
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Commission No. mr 16. 200
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE -
COMPLETED
ev.