HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_ , UPermit Number:
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Building Permit Application AUG 2 4 2WI?
Planning and Developinen t Services
Building and Code Regulation Division gg Lucie c:ocsrt �
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: nc�vtw ec fou
Address: , —1/9 O 1, soe. !�.ra,IC l7vr
Legal Description: +n (ih4j2 G3 NV
Property Tax ID#: 3 Ll 2,• O ?- 13026- I t ' d Lot No.
Site Plan Name: Block No.
Project.Name: �"'�� _ �•�i
Setbacks Front �J Back: Right Side:J� Left Side: �4-
� d p
Add
r
ttiona work to a pe orme un er this permit check all that apply*
-,_Mechanical 'Gas Tank T Gas Piping �Shutters T Windows/Door's
Electric _ Plumbing r Sprinklers ^Generator i Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost-of Construction:$ ' Utilities: Sewer _Septic Building Height:
Y
Name- 6 w��3 Name:
Address: Yboi SPc: Company:
City: State: FL Address:
Zip Code:-3t]99:1 Fax: City: State:
Phone No.(272) �'1 3 $ /�3-0 Zip Code: Fax:
e.
E-Mail: /�Gz- pS 1M S t grwv�%1 Phone No
Fill in fee simple Title Holder on next page{if different E-Mail
from the Owner listed above) State or County License
if value of construction Is 2500 or more,a RECORDED-Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City:_ State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Applicatioh'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
commencinR work or recording our Notice of Commencement.
Signature of O her/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ST• Luce COUNTY OF
The forgping instr ent was acknowledged efore me The forgoing instrument was acknowledged before me
this,' day of 20_p by this day of ,20_ by
(Name of person acknowledging) A (Name of person acknowledging)
or
(signatYre of Notary Public-State of Florida) (Signature.of Notary Public-State of Florida)
Personally-Known OR Produced Identification %V/ Personally Known OR Produced Identification
Type of Identif atio f Identification
Produced KAREN S. NIEL f{ pd ed
�- Commission # FF 1 5637
_r *= My Commission Fx fires
Commission No.� 's eal) lune 2, 201 acom sion No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW.
DATE
RECEIVED
DATE
COMPLETED
ev.7/203.4