HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / Permit Number:
sI� - •
_ Building Permit Application
Planning and;DevelopmentServices
leuilding-and Code Regulation Division
12300 Virginia,Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
"fIRMIT�APPLICATION FOR:
Address:VAT N&e eJ - 41,.Z ,, &Wknda-z4 ' &1. 3 eggs 7
Legal Description: Ld-/ `l3 C-JeC .0-r A.,*7Ce;4 Ale h 2 .zs`�a�
l�0.01 l92 /.�09/l � rs ie i17.f'a
Property Tax lD#: !/SDS -J-D/ -0 S V-o oO,/V Lot No. �?,S
Site Plan Name: /A/A / Block No.
Project Name:
Setbacks Front_�i Back: Right Side: �� Left Side:
J
i
Additional wor to be performed 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:
t
Cost of Construction:$ Utilities: —Sewer .—Septic Building Height:
Name o r1A er✓ / :Name:: ' A
!:Address: .:�7!:3=`S`' VeY G eJ �wd Company.:.,06k,
City aci� f 6hGGd Li, State: Address: i
Zip Code: ,3-y`gs'7` Fax: City: t✓Cc State:
;Phone No Off'. 90/-aOJ93 Zip Code:,3//9 Fax: ?72• V61 edvj r
E-Mail: Phone No 77.2^VAL. aZ//4
Fill in fee simple Title Holder on next page(if different E-Mail TO 0*7, Sky )C I/a1ieo. CQs+4
from the Owner listed above) State or County Licensed'CG/3//S/SO�
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:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: X Not Applicable
Name: Name: 7—
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 theermit.holderto build the subject structure
which is in conflict with any applicable Home Owners'Association rules,bylaws or anscovenants 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 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,cons'ult with lender or an attorney before
commencine work or recording your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Vg�nZure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Jd� COUNTY OF AA1
The forgoing instrument was.acknowledged before me The forgoing instrument was acknowledged before me
this_day of p.20 by this—day of -------#20 by
1 Von'..
Name of person making statement. Name of person making statement.
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature ot Notary Public- dT"gtg$kMNA.*GjA _RAWN�3-lSiinature of Notary Public- ate of Florida
Commission No. MISSION#GG 2760 D
QP' ;_ . -
C
EVDecembej%20,20z C6mmisslon No.
Www TWU Way NW W&rwii
A "'SHMNA
GG 27
REVIEWS FRONT ZONING. sSUPERVISOR PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED.
0 L
.