HomeMy WebLinkAboutSloan Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: _)U01
Legal Description: }"r cice r'S
Property Tax ID #:�
CONTRACTOR:
Q00
Lot No.
Address:" -,_A
Company:
Site Plan Name:
Address:'
Zip Code: ��1� _ Fax:
Block No.
Project Name: _
Setbacks Front
Back: night Side: Left Side:
06, 0� Ll . ,lam r(7IZ U V G
CONSTRUCTION INFORMATION:
A o work to be e Orme un e_r t is permit — check all apply:
HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers Generator El Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: S
S Ft. of First Floor-
Utilities,
loor:
Utilities:Sewer 11 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 4 A Is
Name: �2,0
Address:" -,_A
Company:
City:1 k State:
Address:'
Zip Code: ��1� _ Fax:
City: ]rAP''i _ State: -FL
Phone No.
Zip Code: I`
E -Mail:
�Fax•
Phone No. 'S\S011g1
Fill in fee simple Title Holder on next page ( if different
E -Mail:
from the Owner listed above)
State or County Lice nse:C EKIa�\46
If value of construction is $25U0 or more, a RECORDED Notice of Commencement is requires.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
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 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 most 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 r rding your Notice of Commencement. �---�
Signaturebf OwaeVLessee/Contractor as Agent for Owner I signature
Holder
STATE OF FLO DA STATE OF FLO DA
COUNTY OF ►�vw i�Er � COUNTY OF iA{'i"�
The for ng ins#run: ent was acknowledged before me The forging instr ment was acknowledged before me
this ay of 20 I-1, by thisaA- day of ' i l t 4- 20 L`1 by
(Name of person ac ledging ) (Name of perso acknowledging )
&&tk Q�_ (�rktr Git�j
(Signature of Notary Public- State of Florida j (signature of Notary Public- State of Florida
Personally Known OR Produced Identification
Type of Identification Producp_d
Commission No.
Revised 07/15/2014
a Pu 2012 0
Ota a of Fly :da
1, y p{"jjjl C OYI �� t57EG 5,�
Personally Known / OR Produced Identification
Tvpe of Identification Produced
NO. � aT�Y "ue ts�&� y , is�+EEi SC2tP of 'rlaild2
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
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DATE
COMPLETE
INITIALS