HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO-MUST BE COMPLETED,FOR APPLICATION TO-BE fiCCEPTED
Date: Ferrriit Number:
Building Perm t Application
Planning and Developmentservices
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®ROSEID 1N1WMAE,M`ENT LaC/ATI®'N:
Address: D rc4Gi c.,/,P b X/ ;C/rc
Legal Description: Al. %CrCC a--r-We4 / �F'-?�'•T3� J b/r dC,4,-Y op to/ L C�✓l
Property Tax ID#: 3.2 -S0 O O 4� 02 Lot No. 17,
Site Plan Name: Block No.
i
Project Name: 4 ✓
Setbacks Front Back: Right Side: Left Side:
DfT ILED DESCR11P1 Jill TtO1111
N ®.F WORK:
74
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CONSTR'IJCTlON IN'F®R11AAMMION:
Add itiona I work to a pe rtormed under tis permit-check all t atap
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ J--7 Utilities: _Sewer _Septic Building Height:
®UVNERLE�S�SEEk� ��C®NT ACTOR:
Name Name: Ao7C
Address: ! 0;76 7.fc�Gw�� AZ Com par Y':, Ca�td�•.-1� G�� as��
City: �I.e G; State:�_l "Addres G ��•f ~^(�cira e- �1:r.�f
Zip Code: Jy 9VLr Fax: City: C- State:GCl
Phone No. 1'77- /..3—�� Zip Cod Fax:7-7Z-ol6l 6'4rJ-
E-Mail: �� Phone o. 72Z- 1 211.,
Fill in fee simple Title Holder on next page(if different E-Mail: '&-1 44 Q 4-4,0
from the Owner listed above) State oi County License:cCOIC
If value of construction is 2500 or more,a RECORDED Notice of Commence ent)s required. ,
`P �ENIE'NT% L'CON"STRt;CT10'N.LIE I�L..4W N'F, &'"' s :u1ME!
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DESIGNER ENGINEER: Not A licable ��--�
/ pP 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 covenahts.that may'restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
4
In consid66tion of the granting of this r"'equested permit, I'do'hereby agree than 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 no'n-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.
ig ature of Owner/Agent/Lesseetgnature of Con ctor License Holder
STATE OF FLORIDA. STATE OF FLOR DA
COUNTY OF COUNTY OF
The forgoing instru .en was acknowledged before me The forgoing instru e t was acknowledged before me
this LE day of 20M by this 1(aday of Or by
l as hl�
-174o-MOS Stub j c
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida) /
Personally Known OR Produced Identifica LorL Lp"nally Known OR Produced Identification
Type of Identification Produced �� Typ of Identification Produced
^ ,,,�F CHAELANN c
r. Notary Pub,-Stateo`Fc da I �'zYPOF< Public-Staleo'Fo'uo
Commission No. �S 1eaNptary . .
�, r Cammisson=GG+5c25 CO IsslOn NO. GG155"t
P: ^21 �pmm:ss'.pn
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apr a: My
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE`� MANGROVE
COUNTER REVIEW, REVIEW REVIEW REVIEW REVIEW -. REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.