HomeMy WebLinkAboutPLUMBING - RESIDENTIAL f All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /o /S o20/�' Permit Number:
RECEIVDD '
OCT IS2
Building Permit Applica i
ude County,
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:
Address: 77313 SE Pi nes Covt7-4 P6kI �Y,4t� f- Luc�'e, F601z1'al1'- 3V?006
Legal Description: i- S1 ho u_
PropertyTaxlD#: 3a'a� 5ag' dn�a'a�a'.� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
7rl-3 M
S'146r4r-V- M UVi nil S`0Wtx— V74(Ve' C/P l
5
Additional work to be perforrneP under this permit—check all that 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:$ o7 5-0 O o Utilities: . _Sewer ' —Septic*
Septic Building Height:
7Address:
vEW pVert Name:
73/.3 Se,l- .,,IeS CD 0',Lf Company:
City: Q/Z� 8���� /,cI e— State:FL Address:
Zip Code: 31-17X6 Fax: City: State:
Phone No. �3��9Y3 3`7�y- Zip Code: Fax:
E-Mail: 6EVbOA11PoV ( i40/- • Co Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
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: Address:
City: State: City: State:
Zip: Phone Zip: Phone:—
FEESIMPLE
hone:FEESIMPLE 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.
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.thepermit 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 accessoryuses 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.
Signature of Owne essee/Contracto a Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF sa-. Lv�'�� COUNTY OF
The fo�rgoinginstrument was acknowledgeA before me The forgoing instrument was acknowledged before me
this- day of 4c.� ,20� by this day of ,20_ by
(Name of persod acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of identification
Produced t- D Produced
•nrrua•. tMNAMARIEGNENS
q~ �= MY OM ISStON#GG 022023
Commission No. 5 "`- ���December 16,io2o Commission No. (Seal)
Bonded Thru Notary Public Underwriters
REVIEWS FRONT- ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW . REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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