HomeMy WebLinkAboutScan_Doc0346Planning 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 ----
ALL APPLICABLE INFO MUST E,E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_Permit Number:---------
Building Permit Application
PERMIT APPLICATION FOR:To Select from dropbox,click arrow at the end of line
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Property Tax 10 #:33:i0i<,-""lex>-Ocfje)-~o -L{Lot No._
Site Plan Name:Block No._
Project Name:GOe+,..r\LYS
Setbacks Front Back:Right Side:Left Side:_
JokeD
ShuttersIIGenerator
o Windows/DoorsDRoofI I Roof pitch
Total Sq.Ft of Construction:_
Cost of Construction:$_17 ()CJL.f,~
S<y.£!;of First Floor:
Utilities:USewer D Septic Building Height:_
Na me -el ,:::>e...±r.b HAS'
Address:~6,111'14~1!1<w \j
City:{VL.M lm 4-n.State:ill
Zip Code:011 L.{~_Fax:__----::---_
Phone No.]:>:2 -(~"1 3 -,"),Lj-s
E-Mail:._
Fill in fee simple Title Holcier on next page (if different
from the Owner listed ab ove)
If value of construction is $2.;00 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:__Not Applicable
Name:Addres-s-:--------------------------------
City:State:
Zip:Phone _
_Not ApplicableMORTGAGECOMPANY:
Name:Addres-s-:-----------------------------------
City:--=-:.State:
Zip:Phone:-------------
FEE SIMPLE TITLE HOLDER:_Not Applicable
Name:Addres-s-:------------------
City:_
Zi p:Phone:_.._
_Not ApplicableBONDINGCOMPANY:
Name:_
Address:_
City:_
Zip:Phone:_
STATE OF FLORIDA ~-
COUNTY OF Dr:LuCre,
The forgoing instrument was acknowledged before me
this day of ,20 by
S}QLn~J)~~~~~n~o~,_
Name of person rna]Nt statement
Personally Known )<OR Produced Identification
Type of Identification
Produced _
STATE OF Fl.0~~'
COUNTY OF :-r.lU Ure.--
The forgoing instrument was acknowledged before me
this __day of ,20_by
-::y-o..ro=e.~~;;h /1A...
Name of person ma .g statement
Personally Known )(i OR Produced Identification _
Type of Identification
Produced _
(Signature ?,.f~~Y~~!YPublic-C1t1ilte~~).
j ~~o'.~(i\Notary Public-Stateof Florida
Commis ,"~·5 Commission #FF91~§%1ald
~~'"My Comm.Expires Oct •201
"'~.9f BondedthRIUFNaIIOIW NaIIrY ASSn.
SUPERVISOR
REVIEW
OWNER/CONTRACTOR AFHOVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installat on has commenced prior to the issuance of a permit.
St.Lucie County makes no repres entation that is granting a permit will authorize the permit holder to build the subject structurewhichisinconflictwithanyappl'cable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with vo.ir 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 approvec 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
commencin work or recordin our Notice of Commencement.
DATE
RECEIVED
FRONT
COUNTER
ZONING
REVIEW
REVIEWS VEGETATION
REVIEW
SEA TURTLE
REVIEW
PLANS
REVIEW
MANGROVE
REVIEW
DATE
COMPLETED
Rev.8/2/17