HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
[date: _a-_ `-
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
rr-Kivii I AI'NLILAI IUN FOR:
Permit Number:
Building Permit Application
Commercial Residential f/
PROPOSED INPROVEMENT LOCATION:
Address:. 'i G, L C r% ! rC /c
Legal Description: _
Property Tax ID #: r-� - (j O - Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/Auamonai worK to be performed un er t is permit - c eca t at app y:
Mechanical _ Gas Tank _ Gas Piping Shutters
Electric _ Plumbing Sprinklers Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 6%0�J 3' � ' Utilities: _ Sewer _ Septic
NameJ)�aL ICY -r Ill Irl'C; Q A
Address: U . ll _S cir
City: state: �C
Zip Code:RFax:
Phone No. 73d -LILY- ILI
E -Mail: - Y-
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: __Twirl ..
_ Windows/Doors
Raaf Pitch
Building Height:
Company:( -00( Ai r i L�tl MS [')-F TI -i;
Address: 9 C3 _ .r'C'i I n
City: F4. P i erCC State: �L
Zip Code: P,5 Ll ST] Fax: _7,,_1- $U 1 - -3`' ff
Phone No 1
E -Mail C-00 f,� , p 1 • Cr�1
State or County License CAC J E lcfj (}o
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY:
Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: i 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
structure. Pleasecconith sult withpy applicable
Home Owners Association andrreviebylaws ur deed for any rest rents strat ictions which may apply.
prohibit
ibit such
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 our Notice of Commencement.
Signatur f Owner/ Lks5,beXontractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instrum nt was acknowledged before me
this day of 2flj by
r
(Name of pr ,son acknowled O g )
( gnature of Notary Public- St4te of Florida )
Personally Known OR Produced Identification_
Type of Identif'cation
Produced yr C, (elf r Erich Daniel Kracl,
spa NOTARY PUBLIC
Commission No. 196 a rL a STATE OF FLORI
Comm# GG10592
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ev.
Signatur f Contractor/Lic Folder
STATE OF FLORIDA /_ r
COUNTY OF C.� Cf
The forgoing instru ent was acknowledges efore me
this -7 of 20 by
(Name of person acknowl dging )
{Siature of Notary Public- Stat of Florida )
Personally Known OR Produced Identification/,(,-
Type
dentificationType of Iden i#kation
Produced (4_3 94 —' �tAy'4S Erich Daniel ra
Hh
t NOTARY PU L
commission No. Q —� ESTATE OF F O IDA
Comm# GG1 5 5
RONING EVIEW SUPERVISOR REVIEWI PLANS REVIEW `V REVIEW REVIEW S EV EWLE
MANGROVE
REVIEW