HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
J
•
- Building Permit Application
Planning and Development Services
Building and Code Regulation Division1 ' 1\ VVAACI-
OJCP
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: Q�COD
PROPOSED INPRO TION:
1.
Address: Ii v\ Dr� to
Legal Description: Cu
Property Tax ID #: t�tto \ I\\ Goo k — 0C)0,4;;7— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D 10
7 U FORMAP
AaditionalworKtoDepertormea uncler this permit -check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _ Plumbing _Sprinklers _Generator X Roof �__-Ditch
Total Sq. Ft of Construction: (O oD Sq. Ft. of First Floor:
1
Cost of Construction: $ 40,0,0.4,0 Utilities: Sewer _Septic Building Height:
CTOR:
Name Coca Name:
Address: Company:
Giga b ek it C60, ate: Addre : OL
Zip Code: 294kCIS L Fax: City: C State:
Phone No. -77 7, ---AA-7!a Zip Code: Q� Fax�!l3'3�S'fi3Rd�
E-Mail: P h o n e N o -772-S3&-- 6
Fill in fee simple Title Holder on next page ( if different E-Mail--` - C S �iAz �/d Q
from the Owner listed above) State or Cou ty License G f.GCtS? ZZI A
If value of construction is 2500 or more, a RECORDED Notice of Commencement is r quired.
DESIGNER/ENGINEER: of Applicable
MORTGAGE COMPANY:Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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 and that
or 4ovenants 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
commL,ncing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE ORID
COUNTY OF ��al �'
COUNTY OF
The for forgoing mstr ment was acknowled before me
thils.'`! day of A!
The for oin instr nt was a :knowled&e before me
thi by
�y ,,,20Wby
W &U�U."L �
'clay+o�f_m I,20 -f
l�AJA {tQ
V�s�/
Name of ptIlson making statement.
Name of persoaking statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
natur f Notary Publof Flan a JAIME ORn2
FloTq•�
i nature o otary Pmay"
Notary F - Stele df Floud
Y iuti t • Siete of FiondaCommission
No. M{�itHn: Eltpree Jun1,207
ommission No." al duo 1. 2018•Commletbn
I FF 111465
I FF 1114!5ThNWM*ftaFY
Mm.
Adrdgry.N�lk1y
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
GATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17