HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' ��(• I' 1 Permit Number:
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Building Permit Application AUG
jPlanning and Development Services =t' % "ri1:
;Building and Code Regulation Division t
;2300-Virginia,venue;Fort-Pierc(FL4 982
fRhone: 772 462-1553 Fax: 772 462-1578 Commercial Residential
, 1
PERMIT APPLICATION FOR:
Address: o?2 1' ,dl L2 6021
Legal Description: I'M Z_ ('04/40/ !/'/V l U A, L16/L' ���a l��9 GfA/�T/a
Property Tax ID#: 2: Lot No.
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Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pe Ormeun e11is permit—Check all tat appy:
_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:$ � /SD • Utilities: —Sewer —Septic Building Height:
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Name NameAM!e r19 fZ•
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Address: 'li��D ¢ / /.)'-0"?' Company:ae&it9l9 �i c Ax
City: C ei State:JE.E6 Address:Tj� !ViQ IZD 10VC,
Zip Code: q9 Fax: City: 11,117 l i State:2C4�
Phone No. Ys_w Zip Code: Fax:
E-Mail: Phone No :2C?/
Fill in fee simple Title Holder on next page(if different E-Mail 2 Ott eLln)
from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ 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'
OWNER/CONTRAC'T'OR AFFIOVIT: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 acqcees to another non-residential use
WARNING TO OWNER:Your failure to cord a Notice of Commencey result in your paying twice for
improvements to your property.A NJ
e of�Commencement musrded and posted on thejobsite
before the first inspection.If you-i eto obtain financing,consZnder or an attorney before
commencingwork or recordingurice mmencement„7
Signature of Owner/Lessee/Co or as Agent for Owner Slgnat6re# ontractor/License Holder
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STATE OF FLORIDA �{�-;, STATE OF FLORIDA. t
COUNTY OF � C/Ylt � .� COUNTY OF
The forgoing Instrume t was acknowledge efore me The forgoing instrum nt was a wledged before me
this E3-day of .20 by this M day of s 2613 by
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(Flame of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu S t of to id ) (Signature of_.
A °»e rrrrii20Personalsy Known , ced Ide� IfNiEN20 ersonaliy Kno
Type of identification: :, Notary puAriC-5tate oS Florida ype.of Identifi g ►lrf
Produced '�' '
My Gomm.fix ues Ma 15,ZO t my G Etipkes Array 15..20,11
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Commission No. ommission No. q Sea!
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SFA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
-DATE
RECEIVED
DATE
COMPLETED
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