HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO 5 ACCEPTED
Date: Permit Number: ou 03 00
Building Permit Application
Planning.and Development Services
Building and Code Regulation Divislan
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial.- Residential
PERMIT APPLICATION FOR: To.Solect from dropboX, Clic arrow at the end of line
Address: qq
VU
Legal Description-
Property Tax ID#: 7a Lot No.
Site Plan Name: Block No
Project Name- 11 a
Setbacks Front_ Back; Right Side- Left Side:
hn
"I na Work to bLe_1.0rrorm(xV under tWs`perm 1F—_c7eRc_k_a_1l_tbat 8 IV:
na W( El'
rHVAC 13 Gas Tank []Gas Piping Q.Sph tiers Vvindo'ws/Doors
Electric Plumbing []Sprinklers CGe eratof"- El Roof Ftoof pftth
Total Sq.Ft of Construction: Sq. Ft,of First Floor:
Cost of Construction.
44 - Utilities:R SeWL E]Septic Building Height:
!!amei -Wete, Keo IN VNI-0 Name.
Address: �ay Compah
City:V I f;�;11 Rr statelqe Address,
Zlp&e: _ FaX-A17.�11;N1B city: 11 State;
Phone No. Zip Code: F;aX7r?___3q6.—*ry
E-Mail; �� Phone No
fill in feWimple Title Holder on next page(if different E-Mail;
from the Owner listed above) State o untyUcens_e:__._,_,
if value of construction 142500 or more,a RECORDED Notice of Commence t is required.
1
DESIGNER/ENGINEER: Not Applicable MORTG GE COMPANY: Not Applicable.
Name- Name:
Address; Address:
City: State: City: State:
Zip: Phone zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONGING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/'CONTRACTOR AFFIO /IT:Application is hereby made to obtai a permit to da the work and installation as indicated,
1 certify that no work or installation has commenced prior to the issuance of a permit,
St Lucie Coun�y makes no representation that is granting a ppermit will authorite the permit holder to build the subject str4crura.
which is in conflict with any pplicable Home owners Association.rules,6ylawslor anovenants that may restrict or prohifalt such
structure.Please consult wit your Horne 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 th t 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 buliding permit applications are exempt from,undergoing a full ncurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and a cessory uses to another non-residential use
1 WARNING,TO OWNER:Your failure to Record a Notice of Cemmenc merit may result in your paying twice for
impprovernents to your property.A Notice of Commencement mu't be recorded and posted on the jobsite
before the first Inspection. if you intend to obtain financing,cons It with lender or an attorney before
Gomrnencin ork or wording your Notice of Commencement;
r.
Sign o o erj Lessee/Contractor as Agent for Owner Sl i contractor/License Halder
ST FLORIDA 7E O ELORID �I,
C NTY OF <�,l A .iN. COUNTY F ut
.The forgoing instru ent was acknowledgedbefore me The forgoln instrument was acknowledge efore me
this day of��.`,2Q, by this day of _,Zaby
Name of personmaking statement Name of person aking statement
Personally Known OR Produced IdentificationJPyrupd
y Known� OR Produced Identification.
Type of identification Typedehtif cation
Produced d
„.." • CfliAlt A.t _ CEiAIt A. AN
A.
• » MY COMMISS - MY COMMISSION RgWaff &XPIRER May t(Signature of Notary Public-State, w e f Notary Public State ,6
Commission No. (seal) Commisslo No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS EGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17