HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5/ 2 r K_ 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:
Address: Z4 I F0 ,� _� $ r;lo
Legal Description.-
Property
escription:
Property Tax JD #: I L4 03-50(o —0 ,3,S-- (–')c)o – Q Lot No.
Site Plan Name: Block. No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
7itional work to be performed under this permit – check all that apply:
mechanical Gas Tank i Gas Piping TShutters
Electric — Plumbing — Sprinklers — Generator
_ Windows/Doors
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ y O00 . rrJ' 0 Utilities: — Sewer _ Septic Building Height:
Name L.t11 1 J l C � �.. f 1 Name:
Address.--L_1_�Q L,C1 P -- Company: I Al LrhCY—E
City: RLC- } I e C L Stater Address: LU
Zip Code: 3LIGJ S Fax: City: Ef - • V l ecce 5tate:�L
Phone No,
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Zip Code: flml Fax: 77,? Zl,,539S
Phone No 7 ~];)– Ip3`7-- Q 49i
E -Mail Coo/ at,,, so -1 (P ;fir Com
State or County License CA -r— ' /9(30 9
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINE—ER-
Name:—
Address:
ESIGNER/ENGINEER:
Name:_Address:
City:
Zip: Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:.
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no y work or installation has commenced prior to the issuance of a permit.
St. Lucie
s no
structure
which is inc conflict with any applicable Ion Ho ethat
Owners Associranting a ation rulewill
s,abylaws or and covenants holder
thatthat mayrestrict the subject
bit 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.
Signature --6f owner/ L e retractor as Agent for Owner Signatur f Contractor/ is Holder
STATE OF FLORIDA -4-
COUNTY OF�—
The forgoing instrum ret was acknowledged before me The forgoing instrurrIeUt was acknowledgec�efare me
this day of 20� by '
�► ! 1��x 41 1 ! 1 � t �r � ,a' Ir
icatlon_
Erich Daniel Kractr
NOTARY PUBLIC
STATE OF FLORI
Comm# GG 113592
Expires &17/2s°Nc� 'r�0 .r
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
STATE OF FLORIDA �� L) C/
r�
COUNTY OF 1
(Name of plerson acknowl
(egnature of Notary Public- St�te of Florida )
Personally Known OR Produced ldentif
Type of Identification
Produced D; ' C,r(e,?.fe-
•` Y �o
Commission No. �S : a
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7 4
this � day of 26 by
(Name of person acknowl dging )
(Si ature of Notary Public- Stat of Florida )
Personally Known OR Produced Identification
Type of Iden ification J'
Produced 6•flfP�-� �y Erich Daniel Kra
NOTARY PU L
commission No. Q —STATE OF F p IDA
? COrritri# GG1 5 5