HomeMy WebLinkAboutBuilding Permit ApplicationDESIGNER/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 'r t inspection. If you intend to obtain financing, consult w'th lender or an attorney before
commennng ark or recording our Notice of Commencement.
Si na 7e ner/ Lessee Contractor as Agent for Owner
at a of Contractor/License Holder
11
STATE OF FLORIDA
COUNTY OF ��'�
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 21: aR Oa = 20 4f by
The forgoing in en� as acknowle2dOged before me
this � day o f f y
_�
Name of person making statement
Personally Known `<' OR Produced Identification
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced 14
L A�
(Signature of Notary Public- State of Florida }
(Signature of Notary Public- State of Florida )
o,ABv Theresa Anne Fasano
Commission No. NOTARY PU 01}
STATE OF FLORIDA
Comm# GG126275
wwlvl;
Theresa Anne Fasano
Commissio RYms TARYPUBLIC (Seal)
-� -STATE OF FLORIDA
Cpm# GG126275
CE i xp�re
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2.( Z'S 11� 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
Address: WZ 61Da+NE CII- " 00 SA"fNT W 1V f1. 341162
Legal Description: iv W& L"in'11~S PL" httl: aNF 1„n -T 1-1 ( 6(k NA -7 -2f60= 11,85 -29S'I
12$8 - 12k2 : 1941, —1901 19'11- 1'111 - 332'1- 2 5611
Property Tax ID #: 34 UP - -703 -ObS I — Poo -"7 Lot No.
Site Plan Name: Block No.
Project Name: sween-• j 116-9,00F
HVAC
11 Electric
❑ Windows/Doors
11 Plumbing []Sprinklers 11 Generator I r l Roof f 1, Roof pitch
Total Sq. Ft of Construction: 3,030 Sq. Ft. of First Floor:
Cost of Construction: $ 13, opo Utilities:nSewer OSeptic Building Height:
Name (.o ?LtZft- NV SW eJ
Address: $292 SAWoP t41; Cta,
City: T6z-r s'i: "eig State: fL
Zip Code: 34952 Fax:
Name: E -1 -ITC gooF(Wi SaLuTIONS
Company: Zi cAP->v LAO
Address: 'W St� Lcn+co 4N A VV
City: S'Ctnts' State: Ft.
Phone No. -171,- 419- UBO Zip Code: 34114 Fax:
E -Mail: Phone No. -772 W3 '7003
Fill in fee simple Title Holder on next page ( if different E -Mail: et t Ir P-oor-V,S & Mc t oM
from the Owner listed above) State or County License: C CC 13'3 b 3i0
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.