HomeMy WebLinkAboutBuilding Permit Application May 1917 03:08p Kellett&Sons plumbing 7722250259 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: En n Permit Number: 7G� o4g•
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RE C E
Building Permit Application MAY 2 7 201?
Planning and Development Services
Building and Code Reguiation Division
2300 Virginia A venue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: ZC0
Legal Description:
Property Tax ID#: d�tQS—bL Lot No.
Site Plan Name: be u`L1, Cy,,11 �lone C4f1& Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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E-IHVAC 1' Gas Tank Das Piping Shutters ❑Windows/Doors
0 Electric Irl Plumbing O.Sprinklers E Generator Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$_ �' Utilities: Sewer E]Septic Building Height:
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Name_
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Address:_,�S'r 11b4 "ftcrru:t Company: W
City: Qi State: FL Address: z / ' ,0• l'e-
Zip Code:_:3Zbq Fax: City: tl 6u) _864d7-- Stater
Phone No. Zip Code: a,-/IQ Fax:'772
E-Mail: Phone No. '77Z-z7--OF
Fill in fee simple Title Holder on next page(if different E-Mail i I wt.'D j 0 (lj/i&4•&92
from the Owner listed above) -State or County License: (_E Q t1 Z_ ?oe
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
May 1917 03:09p Kellett&Sons plumbing 7722250259 p.3
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DESIGNER/ENGINEER: i Not Applicable MORTGAGE COMPANY: Not Applicable
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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Counter 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 Irdifir.or an attorney before
commencing wo0k otrecording your Notice of Commence A:t-,...
�- �- f ti - s
ure of Owne esse ontractor as Agent for Owner nature of Contractor/Lice;se' aider
STATE OF FLORIDA . q STATE OF FLORIDA i
COUNTY OF V`1C_.. 7-10 COUNTY OF
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Tha, olwnstrunjn was acknowledged before me The forg ing instrument was acknowledged before me
this day of_ Gt 20 LLby this -of 1/1 r-i 20 by
(N o person acknowl ging) (Na of person ackn edging)
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i nater otary Public-State of Florida) ( • nature o otary Public-State of Florida)
Personally Known OR Pduc d Identification `moi Personally Known OR Produced Identification
Type of identification Produced'F— L Type of Identification Produced 1g- ,"Eat cr;ec6--
r�y n hjY COMMISSION S GG D&6413
Commission N �L ''v , ..• V (c,
HEAL GROGG Commission Ncg�- CC i� -J N -' t
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ISY��MISSION#GG 080419 y \ate IBES:March 7,2021
�,, o" EXPIRES:March 7,208! Of flt� Bonded ltrit Budget NaYery Services
or f� Bonded TtMu BAgo Notary WV99
Revised 07115/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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