HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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:
PROPOSED li
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front— Back: Right Side: Left Side:
r
DETAMED ESCRIPTION OF WORK: T
A % C. CA&A a Q (J4 71 A j -"-------
SEE R-
M9AT thV4
CONSTRUCTION. INFORMATIQw-
itior to a peOrme un Our t is permit – check a tat appy:
YMechanicai — Gas Tank Gas Piping `Shutters
Electric —PlumbingSprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ LL C i
Nam
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
City: '
Stater
_Q_�
Zip Code:
Fax:
Phone No.
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: IS$�' 1 � �
Company: �
da e s A.k,
Windc
Roof
Building He
city: _yea is ectG..
Zip Code: _ 329PC> Fax; _
Phone No 7.2 - 1EzLS2j
E-Mail r% it hll;
State or County License It
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
No.
k No.
Pitch
State: FL,
APPLE
> .CONS RUMON UEN LAW
f ►T t�1 �
DESIGNER/E
GINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Tir
Address:
City:
State:
City: State:
Zip:
Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
of person acknowledging )
BONDING COMPANY: Not Applicable
Name:
r-is'ioature of Notary
Name:
Address:
Personally Kno
nlj OR Produced Identification
Address:
City:
Type of Identification
Produced
City:
Zip:
Phone:
r r KIMBERLY MENDEZ
' Un MY COM �#GG234874
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Zip: Phone:
OWNER/CON RACTOR 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 Countyy akes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contli with any applicable Home owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please onsult 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 TOOWNER: 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 vwork or recording vour Notice of Commencement.
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Signature o
er/ Lessee/Contractor as Agent for Owner
Signature of Contractor t er
STATE OF FL
STATE OF FLQgID
COUNTY OFQ,
Tir
COUNTY OFA E_l jC_
The forgoing in trum nt was acknowledged efore me
_
The for Ding instrument was acknowledged before me
this day o
��C� clomod
2o�by
e_,Z)
this day of�i { j P,k' . 20" by
�ame
(Name of person
acknowledging)
of person acknowledging )
,Z
r-is'ioature of Notary
Public- State of Florida j
{Sign ture of Notary Public- State of Florida )
Personally Kno
nlj OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No.
r r KIMBERLY MENDEZ
' Un MY COM �#GG234874
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ERLY MENDEZ
q*EY.r�e
Commission No. r°''n MY COM �V #GG234874
04, 2022
ExP4REUL 04, 2022
Banded through 1st State Insurance
EXP
°" Bonded through 1st state Insurance
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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