HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,,ll /`
Date: JQ -P - /8 Permit Number: l glu- O(7 ,
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Building Permit Application
Planning and Development Services
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:
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Address: 3280 S. 7T` f r,/ pr7. piE7Z ee
Legal Description: /('1,4/!;A ✓/U, 6 A/1.Z e-04.1 S/2:11 —" 'ir T/-1/Zce - ,.S' /Z 6'. Sy, T
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Property Tax ID#: Zy27-6 )/- ODS7-ooO..- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be-performed- under this permit—check all that apply: r�
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: j o 8 Sq. Ft. of First Floor: //13
Cost of Construction: $ 80 0 Utilities: _Sewer V'eptic Building Height: Z ST.e y
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Name fd.Z/4 6r/Zdu,✓.4) 4C SLC GGG Name: J/XY P. JU/•/CD
Address: Z076 NI /F/T z.) / *xi Company:., /siOf9C s 61--
City:
LCity:. ".TE•✓J'en/ ,3c//C/' State: [L Address: Ar3 2 Sia J14C,C 41/C
Ziip.Code: 3'/9S7 Fax: City: P4/Z> fr Le e"Cr State: ,r-6.
Phone No.I, (03/ — 7VS - 798o ,.Zip.Code` ' 3 yC!'S"3 Fax:
E-Mail: • Phone.NO 772- 9z V - 4 .74
Fill in fee simple Title Holder on next page(if different E-Mail JA /#J )e&--ic/1 //1 '1f ea H
from Vie Owner listed above) State or County License t 1 t /121'41/
If value of construction is 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: I/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 conflictwithany applicable Home Owners Association rules, bylaws or and covenants that may restrict orprohibit 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.
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Signature of ow r,/'essee/Contractor as Agent for Owner Signat Contr /License Holder
STATE OF FLORI STATE OF FLORI A
COUNTY OF 7 ,� �LU,G,J.0 COUNTY OF .
The forgoing instrumentacknowledged O.Vore me The for oing instrument w cknowledged before me
this day of DG( , 20 y this Yday of Q ,20126y
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Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification '' Personally Known OR Produced Identification
Type of Identification J� J Type of Identification I
Produced dL./(� Produced u
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of NotaryPublic State lorida - <_ _ �,
(Signature ) ��„ (Signature of Notary Public Sta, of FloridaFlonda.) „ o,,.
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Commission No. (Seal) cry ; Commission No. (Seal)--day oco FRONT ZONING . S 'gI sDS3 PLANS VEGETATION SEA TURTLE •r'0�.C►V.
COUNTER REVIEW . - 19e/t1= W REVIEW . REVIEW ..REVIEW rn >
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