HomeMy WebLinkAboutBuilding Permit Application ALLAPPLJCABLE INFO MUST BECOM PL=FORAPPL I CATI Ch's TO BEAOCEPMD l I
Date: ' 2-6 b Permit Number: -
RECEIVED
�u LST.
UN 2 S 201`
Building Permit Application
Planning and Development 8i rvices cie county, Permitting `
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce 834982
Phone: (772)462-1553 Fax: (772)462-1578 Commerdal Fbddential
"F'ENIITAPPIKA ION FOR To Select from dropbox, click arrow at the end of line
PROPOSM IMPROVEMBVT LOCATION
Address: /�C�ti, MIAO Ae A:!14'
Legal Description:
Property Tax I #: ' —oz -= Lot No.
Ste Ran Name: Z A!! �P/� /�'// �0 �` q,�/ T_ Block No.
Project Name-
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ame:Setbacks Front Back: Fight Sde: Left 9de:
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OO�ISTRIJCT'9N:INFOI�1 A ANON
i tions wog;to.l e e orm under
this
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- sperms - a apply: . .
HVAC Cas Tank ❑Gas Piping" _Shutters EWndows(Doors
0 Electric 0 Rumbing [],q)rihklers 0 Generator Fbof Roof pitch
Total Sq. Ft of Construction:— R.of First Floor:
Cost of Construction_$ UtilitiesSewerSeptic Building Height:
Nam Name:
Address O & Company:
City: State: Address:
Zp Code: G Fax: City: gate:
Phone,.NQ::. 7-� q 66�2 / 0 J�-J Zip Code: Fax:
C4 Q,oo Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
fro he Owner listed above) Sate or County License:
as
ITialue of construction is$2500 or more,a REMRD®Notice of Commencement is required.
JPPL81/IEN ALOiNSTRUGTION LIB�I LAW INFOf�MAT10N P
DESIGNER ENG NEER _Not Applicable MORTGAGEOOMPANY: Not Applicable
Name: Name:
Address: Address:
City: gate: City: gate:
Zlp: Phone Zip: Phone:
FEE SM PLETITLE HOLDER Not Applicable BONDINGOOMPANY: Not Applicable
Name: Name:
Address: Address.
aty: aty:
Zip: Phone: Zp: Phone:
OWNER CONTRACTORAFFI MAT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation hascommenced prior to the issuance of a permit.
3.Luce County makes no representation that is granting apermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home OwnersAssoaation rules,bylaws or and covenantsthat may restrict or prohibit such
structure.Please consult with your Home Owners/Association and review your deed for any restrictionswhlch 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 usesto another non-residential use
WARNINGTO OWNER Your failure to Record a Notice of Commencement may result in your paying twice for
im rovementsto 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
oommencinq work or recordina vour Notice of Commencement.
9gnature of Owner /Con ractor asAgent for Owner 9gnature of Contractor/License Holder
STATE OF FLORI DA STATEOF FLORIDA ,
OOUNTYOF OOUNTYOF
The forgoing instrument was a(*mowledge,before me The forgoing instrument was acknowledged before me
this A3 day of A/)/' 7 20/ by this day of 20_ by
ANIeD'e i'►l..ear5
Name of person making statement Name of person making statement
Personally Known ✓ ORProduoed Identification Personally Known OR Produced.Identification
Type of Identification Type of Identification
Produced Produced
(9gnature of Notary Publ' gate of Florida) (9gnature of Notary Public-gate of Florida)
SIENGM
Commission No. 6705 ill +°�'`� al COMMISSION#001 mmission No. (Sial)
* * I�IYCOMMISSIONt�GG
e I:XPIRES:Apn14,202
Ian9eY7fw6xFf�tNe�ny
RI MBAG FRONT ZONING SJPERMSOR PLANS VEGETA11ON TATURTLF MANGROVE
OOUNTER REV BIB REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECBV®
DATE
OOM PLET®
Rev.8/2/17