HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number
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Building Permit Application
Planning and Codelopmept
i Services
Building and Code Regulation Division
�FOnnL�
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential��
PERMITAPPLICATION FOR: P45VT �ear b
01W INWVEMENT L ION:
Address: t i&
J 6 a "10 -
Legal Description: (G`3
Legal
L6 NAJ�?. OL.6 I
Property Tax ID #: Lot No. Z�
Site Plan Name: Block No.
Project Name: 7iG1a14-u
Setbacks Front Back: Right Side: Left Side:
ED DESCRIPTI
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CO � 1 IN D
Y010itional
worK to De perTormea un er this permn — checK all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _%t/Roof ._K L(\ 1Z. Pitch
pin
Total Sq. Ft of Construction: ( `l —\ Sq. Ft. of First Floor:
f
Cost of Construction: $ 7,DODiOD Utilities: -Sewer Septic Building Height:
LESSEE:. OR:
Name
I
Name:
Addr ss:
Company
City: State.VL—
Address:1141 5W
Zip Code: ?( $'7i Fax:
City: State:
Phone No. 777,,— W7— 61077
Zip Code:3�Fi$ Fax7�
E -Mail:
Phone No T7 3s -
Fill in fee simple Title Holder on next page ( if different
E -Mail -}-r!; \\o6 GLZ� %' - r1of
State or County License 57 A 146
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is reclu fired.
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLEHOLDER: ..<� Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby -made to'obtain a permit td 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 a4thorize the permit holder to build the subject structure
which'is in cd ct�with any applicable Home OWnars Association rules, bylaws oc aatl covenargts that may.rgstri6t oroprohibit 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, IAO hereby agree that I will, in all respectsrperform 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 concurrencybreview; rggorn additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to anbfher noxi -residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may resuk 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
cominencinR work or recording your Notice of Commencement._
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Signature of owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holde
STATE OF FLORIDA,
STATE OF FLORIDI,
COUNTY OF S T LVG�
COUNTY OF S't t �CJ;..,
The fo going instr ment was acknowledge efore me
thiis day of �`{� 2Q 5by
The forgoing instrument was acknowledged efore me
day
1 \�
this !V of 20�y
_
VJ dtJ = L_dSs�La/�.
Name of Mson making statement.
MAMA
Name of pe6A making statement.
Personally Known _JLZOR Produced Identification
Personally Known vatOR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No 06f4brida ) . -=
..
(Signature f o f Florida
CMOY L A,'
Commission No = t� �� Noiary,Pu6Lg. py >
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X •'r';,,&,,, f CINDY L �.
Commission .% Notary Public - Seal)
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MI COmrh. ExpVeriul 6, "'M
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CDMissia
OR
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Comm. Ezpire5 dui
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REVIEWS
FRONT ZON}jVG
SUQEVISOR
PLANS
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MANGROVE
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COUNTER REVIEW ,
REVIEW
REVIEW
REVIEW
REVJE1al
REVIEW
�
r DATE
RECEIVED
DATE
COMPLETED
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