HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I C) -- v--1 - 1�] Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginio Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPROVEMENT LOCATION.
K`
Address: �00'3) A, Ekyou
Legal Description:
Property Tax ID #: I LIZG ^ -101- 0 1 Lp'-1- 390-S..Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front
Back: Right Side: Left Side:
DETAILED; DESCRIPTION OF WORK:
CQNSTRUCTION INFORMATION:
Add itiona worVto e performed under this permit - c epi cfc-a"Ikt
F R/L .(JLCE.
at app y.
L-- lechanical _ Gas Tank
Gas Piping
Shutters
Windows/Doors
Electric Plumbing
_ Sprinklers
_ Generator
Roof Pitch
Total Sq, Ft of Construction:
Sq. Ft.
of First Floor:
E -Mail:
Cost of Construction: $ a , ucn . C
Utilities: _
Sewer _ Septic
Building Height:
Q'firYY'N`
F R/L .(JLCE.
s:_ p`'s�
I P�
CONTRACTOR.. N
Name t
` � 1 ��
Name: . kOf G IC
Address:
--
Ir Ci.
Company: �fi.i1 I ir]C'25 C_L
City: I 1
Zip Code: E \
Phone No. �31 - 33/J_-
state: (lei
Fax: G
q 194 _
Address: Lr, 90__"> Cc�bGr-i�:;_ Lo�
City: C? f `V `P l 'i ( State:
Zip Code:/495 V. Fax: - -ya - 'o'c`i"SY) 9
Phone No !1 �- C1 L1 C)- ��C)
E -Mail:
Fill in fee simple Title Holder on next page f if different
from the Owner listed above)
E -Mail w I I • 'C' l
State or County 'License CSC- 19 v (:)Ocl
If value of construction is 2500 or more, a RECORDED Notice of Commencement is requires.
M �TAL CSN' RU:T10N LIEN. LAW INFORMATION:
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: 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 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
commencing work or recording your Notice of Commencement.
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Signature)a�Owner/ Less oh-lfactor as Agent for Owner
Signature of-C-bntractor/Lice�,s.6o der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF ,, I✓ t C: r
The forgoing instrum t was acknowledged before me
this I (� day of r1 20fii by
6b i�J F -) y1 ' C 'Z_A JC-
(Name
G
(Name of person acknowledging )
(Si ature of Notar ub ic- State of Florida )
Personally Kno n .•z• ' P,, ,OR Prodi udA Lft6flifiiWtion
Type of Identifaza€��r' s ` ` Notary Public - State of Florir!a
Produced fliy Comm. Expiras San 27,201G
.;fF f Cemr�� ion FF 06342
Commission No��
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrument w s acknowledged before me
this day of c�bP,--zol i by
�C Z f
(Name of person acknowledging }
(Stgnature of Notary Public- State of Florida )
Personally Kno"
Type of Identific
Produced
Commission No.
ZONING SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW REVIEW
Rr-Merced°Identlticatlan _
C;,'11i1E LUE STW-L
Notary PuYic - S° :,s
I,',yr Corm €:epi . "7, grit
COnlfi'ISSiO�$`�8�f 1nr��,�`)
SEA TURTLE MANGROVE
REVIEW REVIEW