HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE
CABLE INFO MUST BE CdMPLETED FOR APPLICATION TO BE ACCEPTED
Date: F4rnit Number, ow
Building Permit Application
Planning and Develbpm6nt Services
Building,dnd Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(771).462-1553 Fax.,(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR; To Selectfrorn dropbox, click arrow at the end of line
Address: -6—rKl
Legal Description: � �
Property tax ID M. —0
Lot No.
Site Plan Name: Block No.
Project Name-
Setbacks Front_ Back. Right Side: Left Side:
7 76t) -4
na work to b[—'
rformed uncler this perms C eck all ap)1Y.
HVAC GasTank Gas Piping —Sh Itters Windows/Doors:Electric plumbing Elspriinklers 1:1 Ge rierator Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of F rst Floor:
Cost Of Construction: Utilities:10 Sew r Septic Building Height:
HVAC
F� Re
Name Name 19 V 6-,1Vn91-5JY)A-h n
8-nn t
Addre Company
City: State Address,
Zip Code:' city.
.
State:
Phone No.�- `'^0 tip Code:
E-Mail: Phone No'
Fill In fee pie Tittle Holder on next page If different E-Mail:
from the Owner listed above) State o;7:)Unty Licens'e-, Iq
0 value of construction Is SZSW or more,a RECORDED Notice of Commence ent is required.
DE"SIGNER Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: i State: City: State:
Zip: Phone Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: Not Applicable BONDINGCOMPANY: _Not Applicable
Name- .� Name:
Address: Address:
City; Dirty:
Zip: Phone- r Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application Is hereby made to obtair a permit to do the work and installation as indicated.
1 certify that no work or Installation has commenced prior to the Issuance of a permit.
St.LNcle Count�yy makes no representation that Is granting a permit will authorize the permit holder to build the subject structure
ss
which ss in contilct with any applicable Home Owners Aociatlon rules,bylawsor and covenants that may restrict or prohibit such
structure..Please consult with your Horne Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,l do hereby agree tht I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St_Luci'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 aaccessory uses to another non-residential use
WARNING TO OWNER:Your failure to;Record a Notice of Corn*menc iment may result In your paying twice for
improvements to your property.A Notice of Commencement mut be recorded and posted on.the jobsite
before the first inspection.If you intend to obtain financing,cons'h with lender,or an attorney before
commencinwworkorpocordingvour Notice of Commencement'.
.Sign, a d en/Lessee/contractor as Agent for Owner ZTE
Contractor/License Halder
r
ST F FLORIDIJ O FLORIDA-4thtt,X,i
C NTY OF �,��[`� COUN`tY OF
The. orgoing Instrument was acknowledge before me The�i g Instrument was acknowledged before me
th�aay of cL&.�_ ,20 I by this y of ,24by
Name of perso making statement Name of pers Wmaking statement
Personally Known OR produced Identification Personally ,own OR produced identification
Type of identification Type of.IdE ratification
Produced! produced
."' CRAIG,A.ORO BMAN CRAI8 A.tR s MAN
''�"�AY COMMISSION PF$MD2 ��` +•€ MY COMMif3SIC}fi
1 . '' 1
(Signature of Notary Public State , gnatu a of Notary Public-State
Commission No. (Sea]) Commissio ri No. (Seal)
F I
REVIEWS FRONT ZONING ; SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE '
COUNTER REVIEW -REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17