HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
^ 1 . r- -
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-157$
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: ! c9--aA I
Site Plan Name:
Project Name:
Permit Number:
Building Permit Application
Commercial Residential
Lot No.
Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WOR
A/ d[A e 0
SF -e R
-flEAT
&CONSTR��UCTION INFORMATION:
onato e per orme un er t is permit — c cc a t at 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: $ Utilities: —Sewer —Septic Building Height:
OWNERf LESSEE; ,
Name l�
Address:
City: V Stater
Zip Code: Fax:
Phone No.1—l7r ~ !i �_. 071„x,
E-Mail�,�--ii
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:�dGr�J►es 64
Address: 872SS
City: e-'_0 13"e- State: kL
Zip Code: '32W> Fax:
Phone No -7 7%-
E -Mail lti Gid ►r ,�a±�• COAJ
State or County License t. AC -/9/9900
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:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 your Notice of Commencement.
Rev. 7/2014
Si of Owner/ Lessee/Contractor as Agent for Owner
Sig tractor/License Holder
STATE OF FL RIDA
STATE OF FLORIDA
COUNTY OFs JCA
COUNTY OF
The for Ding instrume t was acknowledged before me
The forgoing ins ume t was acknowledged before me
this day of 20A by
this 5 day o 2D� by
I omp)z
Nw—kI ki D AAA. Q,2
(Name of persona knowledging }
(Nam of person ac nowledging }
*\ , yz i2d 0 j
'W&06�-L
(Sign ture of Notary Public- State of Florida)
(ign ture of Notary Public- State of 'Florida )
Personally Known )� OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
,aY.•,�a KIM €RLY ENpEZ
Commission No. MYOOM4fS��hd #GG234874
KIMBERLY MENDEZ
Commission No. f . w,�n KIMBERLY
AIRES: JUL 04, 2022
EXPIRES: JUL 04, 2022
a
°F"' Bonded through 1st State Insurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014