HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECErveo
• JUL 01
Building Permit Application St tiUgDe,:.� .
Planning and Development Services
cip
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:
PR a
Address: JL40 O / Q- S
Legal Description: SU11J4-Ar,>A0 C,A 61-V- i-OT 15'
Property Tax ID#: 21L4 O 5_-(701-0079-QDO-Q Lot No. 1
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D TAILED DESCRI N 0TW67F,
A 'c _ lue"LJ C't �AD
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Additional work tobe performed under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Boo Utilities: —Sewer —Septic Building Height:
Name 15ZVCrLy k2-t,It F,imej Son) Name: ���.✓�✓�� vw cI tf
Address: _?L400 4✓t_° .S Company: -f. S,,.,, 7- &,f c,7r.c-,L_ d-R -✓
City: r_'0 c t State: jEL Address: z) b tct F Ov-
Zip Code: 3 tt 4 Lt f2 Fax: City: fes('L f+kJ,00 State: XL
Phone No. Zip Code: 32_i;�L Fax:
E-Mail: Phone No 8 ( 1',> /�
Fill in fee simple Title Holder on next page ( if different E-Mail �. s✓►, ti'r l� -S�✓lc est Cd- e0".
from the Owner listed above) State or County License 5"77
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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.
A�Al /�� '/ /" —
Signature of Owner/Le se Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 2-61111 to COUNTY OF
The for oing instrument was acknowledged before me The fo4oing instrument was acknowledge.before me
this day of 20�by this � day of _3 y 120/Q by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification oL Personally Known OR Produced Identification
Type of Identification-}� Type of Identification
Produced ,1/L_- Produced zli
(Si nature of Notary Public-Sta of Florida) (Signatu a of Notary Public-Stat f roricla )
Commission No. (Seal) ;as•tio,, Commission No. (Seal) ;:�•"ti
REVIEWS FRONT ZONING U ygt it PLANS VEGETATION SEA TURTLE MA RgVEm
COUNTER REVIEW o REVIEW REVIEW REVIEW RE �3 io
DATE
RECEIVED
DATE a
COMPLETED $� c�a C °DO cia W
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