HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date; Permit Number:
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Bu "i1di* ng Per 'it Appl 'icat*ion
Planning and Development Services
Building and Code Regulation Division
2300 Virginia , Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: 462-1578 Commercial i ti l
PERMIT P P LI TI I FOR : To Select from dropbox, Irl arrw t th nd f lin_
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Address: Z QIQ.�2
Legal Description : 1114 0)VYe-J,0 znq-02,0ew
P ry p e rty Ta x 14 Lot No.
Site Plan Name : Bloch No.
Project Name: 2tqz .50
SetbacksFront Back: Right Side : Left Side
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Idditional workto be ertormedunder this permit — check all apply:
HVAC Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction : S Ft. of First Floor:
Cost of Construction : Utilities. Serer Septic Building Height:
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Namez�l.�qk - ite Name,
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Address. z9e-ean 5- Z— Company.
ity: 150State: Address:
ip Code: �rl Fax* Cif �� State: �6-o
P ho ne N . 'P2 0 0P1'X' ,/ Zip Code. er Fax: -�2
E-Mail: op,
Fill in fee simple s*mple Title Holder on new page if different E-Mail : �� J� � � � fVr-,4 �h —
from the Owner listed above) State or County License :
If valu f constructionis $2500 or more, a RECORDED Notice of Commencement Is required.
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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.
certify that no work or installation has commenced prior to the issuance of a permit.
StAucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which► is in cantlict with and 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 Maya pply.
In Consideration of the granting of this requested permit, l do hereby agree that I will, in all respects, perform the work
in accordance with tie approved plans, the Florida Building Codes and 5t. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full coycurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessary 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,,
Sign atu re OlTwner/ LesseeJContra cto r as Age nt for own e r Signature of actor/License Haller
STATE OF FLORID STATE OF FLORID��� T �
COUNTY OF_ �%9� �� �'_ COUNTY OF
The forgoing instrument was a nowledged before me The forgoing instrument was acknowledged before me
this day of 20.& by this day of ��°����, 20,�Y by
Name of per on making statement Name of per on making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
lgVfwfe of N (SigKa 1 1%09 MAW
•'•" •�i,�, JEFfrREY $. LONG �fi►+a'� ail JEFFREY B. Ld G
Commission No. NotoFy Publ145409 of Flpridt Commissio Notary Public - Ste_tf do
• � msnitSWn * FF 180581 UMMISSIon *
My Coiam. Upires Mir 23s 2019 ��•� , Any Comm. expires Mir 73, 2019
HWAVE MUM As S-0---
�otded 1►I�lorial Nogr�l Ate.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE I ,
COMPLETED
Rey. 8f 2/27