HomeMy WebLinkAboutBuillding Permit ApplicationAll APPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Cp-,'1j _ / F Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial L---- Residential
PERMIT APPLICATION FOR:
PROPOSED fNPR01/EMNT LOCATION
Address: Ll I LCI
Legal Description:
Property Tax ID #: 1 LI ;t3 - 5C)& W -73 r-+�nQ-
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No._
Block No.
ional work t0
Mechanical
Electric
rmeo under
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 3, 900. 00
permit — check a
Gas Piping
_ Sprinklers
apply:
Shutters
Generator
Sq. Ft. of First Floor: ____
Utilities: —Sewer —Septic
— Windows/Doors
Roof Pitch
Building Height:
Name?jpbr-]-- Ju r (.0 i_ CZ Name:` c f )L
Address: Ll I U0 11 V41gbLtnQ I A-1 -A Company: 1 00 (4"1 _
City: a)(-+ I�)ef—Ce- i State: FY Address: L! Q C),3 Lok jL
Zip Code: 3 Lf % / Fax: City: F_b(4 f % i Ct C6'- Stii�ate:�L_
Phone No. Zip Code: —31195 I1 Fax: � F0 )_ J3%Y
E -Mail: Phone No 7_o - r�y-0 7
Fill in fee simple Title Molder on next page ( if different E-mail C oca f Qf r So/ c rca , Cam
from the Owner listed above) State or County License( F � oa
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
!1�i`►STRLICTICON LIEN LAW INFORMATION
DESIGNER/ENGINEER. Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
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.
7si �L Ci
5ignatur f Owner/ Lessee tractor as Agent for Owner
Signature Contractor/Lic.ens milder
STATE OF FLORIDA . f (
COUNTY OF L.
T OFFLORIDA/
C,
The for ing instrument was acknowledged before me
this to
of 20� by
The for ing instrument was acknowledged before me
this �ay of 20_M by
Av/etji
U
{Name of per ackno dging }
{Name of Pers acknowledging }
r�
{Sign ure of Notary Public- St to of Florida)
Personally Known OR Produced Identification
Type of Identificatio 1 Erich Daniel Krach
Produced tI NOTARY PUBLIC
STATE G 1059 5
Commission No. i L " �. �1w,c�,m# GG1Q5925
Expiren 511712021
(Signat re of Notary Public- State of Florida j
Personally Known — OR Produced Identificatio/
Type of Identifii nation
Produced �" � �i Uriah Daniel Krach
v NOTARY PUBLIC
Commission No. + S ATE OF FLORID
� �
a comm# GGt 05925
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VLGETATION SEA TURTLE
REVIEW REVIEW
MANGROVE
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.