HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: T� �� Permit Number: l4 O 5J d( °'U
RECEIVED
Building Permit Application
Planning and Development Services Luce County, Permitting
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:
_N_
Address:
Legal Description:
Property Tax ID#: ?`�fj`� - )�� - C Com' 2 ado '� Lot No.
Site Plan Name: Block No.
I
Project Name: Wffi
Setbacks Front74 Back: fight Sicic� Left Side: 1 n k Of `z
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CON STR ION INFORMATION:
Additional work to be performed un e�this permit-ch' eck all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing (� Sprinklers _Generator Roof Pitch
22 L wG "Irk
Ir —
Total Sq. Ft of Constructionq,,b .l?� C4,� int ,�� Sq. Ft. of First Floor:
Cost of Construction: $ L?w Utilities: _Sewer _Septic Building Height:
CONTRACTOR:
Name Name:
Address:%'_-1�b2 V CQ� Company:
City. Cr-d State: _ Address:
Zip Code <1��1ct— Fax: City: State:
Phone No.�'72 2l� 'Z��o2 Zip Code: Fax:
E-Mail:06ee kYl y Phone No
Fill in fee simple Title Holder oh ext page ( if different E-Mail
from the Owner listed above) State or County License
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:1i
(D Address:
City: - - mac. Stale:TI City: State:
Zip.'y1!E1gr ; Phone' 1lc- Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 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 our Notice of Commencement.
Sign3iturL,W Owner/Lessee/Contract r as Agent for Owner Signature of Contractor/License Holder
STATE OF TATE OF FLORIDA
COUNTY OF FLORIDA�t Ik)C COUNTY OF
The fo JJ Sping instrumePt was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 1,S—by this day of 20_ by
me erso ckn led mg) (Name of person acknowledging)
atur ublic-State of gE�. q1 (Signature of Notary Public-State of Florida)
Personally Known OR P, ldl*avAfiifrratt4qPersonally Known OR Produced Identification
Type of Ide icatiQn J ��� S(�` Type of Identification
Produced . Wet-er Z- �L ,*,m.Ex���; Produced
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Commis ion No. �L5-77S S V ;N° ;Q- Commission No. (Seal)
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REVIEWS FRONT ZE � ISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIE ���� �� VIEW REVIEW REVIEW REVIEW REVIEW
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COMPLETED
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