HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICA LE I%FO 4UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Y I Permit Number: ( �
Building Permit APPlication
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 V
PERMIT APPLICATION F•'
' C_ONTRA_C1'I:QR: 'a
Name ( +C.. 1"6- s
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Address: 10 ) S Cwi 1ICY
Legal Description: Lc. i�2W o,^�1 �G,r k - V ►� A �.
Property Tax ID #:I iso, 0 I � 3 - Coln -
Site Plan Name: A e at �VaC Q T TOA
Project Name:
Setbacks Front Back: Right Side:
Lot No.
- hi, ar 1-{r-imi —Jil �ock No.
Left Side: i
Additional worK to be pertormeci under tris permit- crecK all that apply:
_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: $ _ . JiU- Utilities: —Sewer —Septic Building Height:
I
®UUNER/LE-�SSEE:
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Name ( +C.. 1"6- s
Name: �U i���i✓s�S•
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Address: 7000y5-�i�1 9
Company: 9ZU-beN Ajk- GO�kSli/�iV f+�d' �7 riiJ
City: 1-,j . iGrC° Stater.
Address: N%,f7%,5Lt)l
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City: R,) zT- SAZA)y- i-oc.!6-. State: -G.
Zip Code: 3ff 05 Fax:
Phone No. S✓�/-�.�.�-%��
Zip Code:T,Fax:
Phone No
E -Mail:
Fill in fee simple Title Holder on next page ( if different
E -Mail �CJt �jEjU�iiG<>!l�`i�G�itJ%►�. CC-� [�ir'G¢r%�c=�
from the Owner listed above)
State or County License) 57AT�,
IIIf value of construction is 2500 or more, a RECORDED Notice of Commencement is required.)
SUPPLEIWIENT L C�NSTRU'ClII I 1EN LAW I�NF�
DESIGNER/ENGINEER: Not Applicable
Name:
PROM N:
MORTGAGE COMPANY:I _ Not Applicable
Name:
Address:
City: f State:
Zip: Phone:)
I
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
City:
Zip: Phone:
Zip: Phone:
I
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 thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenant's 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 Amend ents.
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
commetmciniz work or recording vour Notice of Commencement.
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Signature of 0 er/ Lessee/Contractor as Agent for Owner
Signature of Contractor/LicensFHolder
STATE OF FLORIDA /
COUNTY OF L� �l
STATE OF FLORIDA
COUNTY OF L�� C
The fo oing instr ent w ac k owledge before me
day
E
The forgoing instrument was acknowledged before me
this of 20�y
this day of _ , 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Nota Public- State of Florida)
(Signature of Not#yPublic- State of Florida )
Pefsor� ��� wn ANGEI�RAFhWuced I ntification
li = 2 y Pub S to of Florida
Type a,
;1 t«"Ec
Personally Known r u ed Identification
Type of Identificati' 2"P'JP�o -- ANGE LA M
: o missi FF 234730
Produced.¢
b,�? ia eSj�j
9onded throu;h National Notary .Assn
Commission No: _ (Seal)
Produced = o HUFF
State of Florida f
-N o ; Commission # F 2340
Commission No. .;FOF �oP �'� My comm. Exp()y 27"2a 19
onded through National Notary Assn.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
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VEGETATIONi
SEATURTLE
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(MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
RECEIVED
DATE
COMPLETED
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