HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE I MUST B COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Applica!ti�on
Commercial Residential
PERMIT APPLICATION FOR:
�P�R P SED INPR®/ M,ENT L CAT4N
Address: 3Z I 5 k_e_1L0_ 'Dol v -e - �
Legal Description: A7 <14CN-&-(i
Property Tax ID #: Lot No.
Site Plan Name: rd/1/%L�� Block No.
Project Name:
Setbacks Front a20 Back: Right Side: _ Left Side:
_Mechanical
_ Gas Tank
Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:' AM
Y1bCost of Construction: $ Utiliti(
Shutters "� — Windows/Doors
Generator ! Roof Pitch
Sq. Ft. of First Floor: ,I
s: —Sewer Septic Building Height:
01NR/LESS
Name' $ D`11E� ba te5
Name: s.
Address:
City: e T &reState:
Address:
__
Zip Code: Fax:
City: 7 u Z ,,I Stater
Phone No. �� �- fy/l
Zip Coder Y 9' 1 Fax:... 76/Y,��, 7
E -Mail:
Phone No 2C 3.7
Fill in fee simple Title Holder on next page ( if different
E -Mail rfl--e `�'�>/�-�3� -9) tioo ,eun't .
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
M.
SM _PP'LEMENTAL CONSTRUCTI®N LIEN LAW kNFOR,MATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 your Notice of Commencement.
Rev.
Signa ure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF L_uc-, --c-
COUNTY OF e --
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this -�2 day of A&V 20_L7 by
this / T day of /11c4 20/7 by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature o ,Notary Public- State of Florida)
(Signature o Notary Public- State of Florida )
Personally Known OR Produced Identificat'
Personally Know
Type of Identificati G DRAWDY
Type of Identification ;�s""�'Yir�;; KARYN G DRQ
Produced �!'ct : KARYN
MMISSIGN # FF198558
Produced MY COMMISSION # FF198558
MY W
RES F ru ry 11, 2019 Commission No: . ",x �`
EXPIRES February 11, 2019•-
Se.com
Commission No. �F�a ME,a ota• �
qac° �a+sa Ne
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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DATE
RECEIVED
DATE
COMPLETED
Rev.