HomeMy WebLinkAboutBuilding Permit Application NOV-02-2011 THU 07 58 AM CENTRAL SCHEDULING FAX No. 3212686138 P• 002
ALL APPLI AB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
date:, Permit Number:
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Building Permit Application
Pldnning and Development services
Building and Cade Regulotion Division
2300 Virginia Avenue,Fort Pierce F4 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
Address:
Legal Description:
Property Tax 1D#: 1 3 •l - `J001-cohs-
Lot.No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: R1ghtSlde, ____Left Side:
1111;1(1'�R—11g'11511
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Additional work o be ertormed under tftis perms --c ec a apply:
1]HVAC Gas Tank Gas Piping _Shutters Q windows/Doors
Electric ❑_Plumbing Sprinklers 11 Generator F1 Roof Roof pitch
Total Sq.Ft of Construction:: �� { S .Ft.of First Floor.,
Cost of Construction:$ "f`I �� Utilities:11 Sewer Dseptic Building Height:
ti, WA,
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Name UY)Q(A U(A V ITO\Q Name: or 6p,
Addr s: d D Compan x .
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City: Je C� State; Addre (
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lap
Zip Code: Fax: City: I G -, State:
Phone No. �Qd� �J � Zip Code: l Q11� Fax.
E-Mail: Phone Not
Fill in fee simple Title Holder on next page(if different E-Mail: 1 m 0
from the Owner listed above) State or County Anse:, M
if value of construction is$7500 or more,a RECORDED Notice of Commencement is required.
NOV-02-2017 THU 07: 58 AM CENTRAL SCHEDULING FAX No. 3212686138 P• 003
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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 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 thepermit 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 lnspectlon. If you Intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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5ignature of ZO
11DAS-t"
Lessee/Contractor as Agent for Owner Signature of Co tar/Llcense Holder
STATE OF STATEOF FLORIDA W fICOUNTY OFCOUNTY OF r �1 L✓
The fo going Instru ent w s acknowledged before me The forgoing Inst yment was ac nowledged before me
this day of 20_.by this day of 26j-
by
Name of per5 making statement Name of person making statement
Personally Known OR Produced identification Personally Known K �OR Produced Identification
Type of Identification Type of Identification
Produced Produced
r•
(Signature of Notary PubAc St E,lor' (Signature of Notary Public-State ,f lorida)
r� r '��tlhertne Danger �. , !", Catherine Konger
Commission N nCr C on#P172372 Commission No. l "e� iaD#FF17z372
.�. �:IJCP 28 2018 - RIplres:OM 28,$018
I3ONDRID THRU 6,+ DONDED TRRU
'�i,n+•' 1SfFLORIDA NOTARx,LLc AIA"LO`r 3.STFL0RiDANOTAAyLLC
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ��]
COMPLETED
Rev.8/2/17
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