HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5 _Q Z- S Permit Number:
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
;..A,�wa ,,, rs .w.�.., , ,, , , ��,. .� � :.� i , �t.2�_,_ __. P.:f.. _v .._�.�.,..a.,>sz,,.a��.� i; �` ... , ,., ixr., .. ..:.�H.�< E. g��a�a� w, .'"��''. ���'.�. ��..�::� e i � � •a��+ �,;
Address: -aG7U C'- C\
Legal Description: �C ��x"�C�`� V;_�il
Property Tax ID #: ����� Lo �— ����' —� Lot No. __7�1
Site Plan Name: Block NoAkn
Project Name:
Setbacks Front Back: Right Side: Left Side:
HVAC
nElectric
"Shutters
❑ Plumbing Sprinklers ❑ GeneratorRoof pitch
Windows/Doors
Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ ��� Utilities: RSewer Septic Building Height:
d<F. -a � ��'i `"• .�$,"�..., .� o�l .�.��--,,.
y
a i, im��SaF.fix. lqa �i� a-S�
Name
Name: n z-"\rx
Address: __TQL(z6
Company: 1p ,
City: 1' �� �\ t�i^C_�. State: ��
Zip Code: 5 Fax:
Phone No. 1-"1Z.) y
j - ,
Addresss:q'_:;x5 kxk3 E lam(" 10�
City:R(:: '+ '� �-� SGC �. State:�l..
Zip Coder Fax:
Phone No. T Z — LkG510 " I
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: AA CA
State or County License: C:xz)— 1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
J9Fui F:N2f
MEOW' ii a. $ 'c....... �....nr..W
DESIGNER/ENGINEER: _
Name:
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
STATE OF FLORIDA
Address:
COUNTY OF SN
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of Identification
Address:
Produced
City:
City:
(Signature of Notary Public- St to of FI%0�1,1 TIFFANY SUT
Zip: Phone:
a� ••'..,�" Commission fF GG
Commission N� tai �* )*mmission
o' ExpimS26,20'22
Zip: Phone:
Pe
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.
Rev. 8/2/17
Si ature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF SN
COUNTY OF �A—
The forgoing instrument was acknowledged before me
thisday of ��o`y 20 t� by
o�
The forgoing instrument was acknowledged before me
this allay of �Y1 20�by
Name of persoq making statement
Name of person making statement
V
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- St to of FI%0�1,1 TIFFANY SUT
(Signature of Notary Public - Skate of Florida j
a� ••'..,�" Commission fF GG
Commission N� tai �* )*mmission
o' ExpimS26,20'22
9 42! ' �* . �6"��, TIFFANY SU17
No.�1 �'�•�• ea l) CommissionikGGl9
m
Pe
� Expires AprH 26, 2
Epp ��Op' BadM Thu Budgot
Services �4O f p�oQA Bodo mru Budget NoUq
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17