HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Q 0
` riltt "� RECEIVE®
Building Permit Application
.JUN 0 5.1019
2 I. ,i Department
Planning and Development Services �a nn meaty
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: �1
Address:
Legal Description: ��" Z n\, Z ` L
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P ioperty Tax ID#: 1 ?,Z- �0 �- c�l,y"� Lot No. _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be pertormed under this permit-check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of Fi t Floor:
Cost of Construction: $ �r`C /b Utilities: Sewer _Septic Building Height:
OF � NE{{RR' �LFS ` y . � � *�� Cg3NTRA�� , t3�R• ���� ����
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Name Name:
Address: Y'` ' Company: n `
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i odty: ,."�� State: AddresZip e:-�GI Fax: / City: State:
Phone No. �12r�3 Z - -7,V Z_ Zip Code: �� Fax:
E-Mail: Phone No Z—
;Fill in fee simple Title Holder on next page( if different E-Mail
1from the Owner listed above) State or County License� �3��Z7i
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address:- Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEESIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name:"'r 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 r corded and posted on the jobsite
before the first i spection. If you intend to obtain financing, consult h lender or an attorney before
commenci w rk gr recording our Notice of CommencemenV 17
Signa r weer/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORA STATE OF FLORIDT
COUNTY OF COUNTY OF `
The for ing instrument was acknowledge fore me The for ing instrument was acknowledged b fore me
his day of :5(/vvV, 20�by this day of�151W'C' 20S6y
(Na e f person acknowledging) (Nary} Of person acknowledgi g)
(S ure o otarynPublic-State of Florida) Signature of Notary Public-
-SState of Florida)
Personally Known , f OR Produced Identification Personally Known CSR Produced Identification
Type of Identifi .s'%, Kim6erlyn M•Q Type of Identificati
►ood �', Kimlaertyn M.Garwood
Produced n. MMIWQn J QNWA22 Produced
C„ s �xRlr@S:,Ian ;� srorri AG•I7A22
-„:....• MY 16,%22 .:• Expiras:Jan
Commission No.''��,' r 8 thx11 Commission t� '.".' ,• o� 16,2Q al)
ry hru Aaron Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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