HomeMy WebLinkAboutBuilding Permit ApplicaitonAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date' Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description: 1 0o
Property Tax ID #: % )
Site Plan Name: `7 Gats-l�
1
Project Name:
Setbacks Front Back:
i C5�
Building Permit Application
Commercial Residential
r
C)o OW
Right Side: Left Side:
Lot No. C
Block No.
Wdaffional work to be pe armed under this permit-- cnecK alt znai apply:
Mechanical Gas Tank —Gas Piping — Shutters
Electric Plumbing _ Sprinklers — Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / G 9 C, Utilities: —Sewer —Septic
11
I nc+.
Name:
Address: l I,- t t.ompany:v c %ztc%tza_ x i
City: i- t' c rc State: �J Address: i T7 14 t�R
Ir
Zip Code: �i 9,' {{� Fax: City: � Y L �
Phone No. Y c -r 1 z Zip Code: 7
E -Mail: _ Phone No
Fill in fee simple Title Holder on next page ( if different E -Mail _TF- N('F_
from the Owner listed above) State or County License Q-1
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Windows/Doors
Roof Pitch
Building Height:
_7T 71C SMA
State:
Fax: 40 7 t
FC I�-ole(3_49
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R- t".7dk7' - ' : •'A'tJ4. ''t`y ° _ i lLY�irl'- +rn. --' j I t 1'
1
DESICMER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: ' Name:
Address: Address:
City: -
State, City_ State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDiER: Not Applicable BONDING COMPANY: NotApplicable
Name: Name;
Address: Address:
City: City_
Zip: P
Zip: Phone:Phone:
OW[VER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or installation has commenced prior to the issuance of a permit.
St Lode Count� makes no representation that is granting a permit will qutbasize the permit holderto build the subject structure
which. is in conflictwith any applicable Horne owners Assocration rules, bylaws or and covenants that may, restrict or prohibit such
structure. Please consultwith your Homeowners 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 Godes and 5t Lucie County Amendments.
The following building: permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walis, 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 posited on the jobsite
before the first inspection. if you intend to obtain financing, consult with lender or an attorney before
commencing work or recordi6&y9yLqgXice of Commencement.
SiRrrai ure oo Owner/ lessee/ rector as Rgent for owner S' ure of Contractor/license holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY a ' � V`A'C COUNTY OF - V-�('I_
Tire fo�rrg�oing inam ent was acknowledged before me The fo^ �oing i ment }gas acknowledge before me
this ` L day of 2l3 i a by this 1 day o� [S : ` 2i} by
Mame of person making statement. Mame of person making statement.
Personally Known —7'2 OR Produced ldentificatlon
Type of Identification
-slgnaftlre of N r r"11 Ftaridn
Pamela Dyer4.1ape
Commission No. UM
� geloerz
a 6115
,n •:
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW I REVIEW
Personally Known 7"-- OR Produced IdentWication
Type of Identification
Pamela DW -Hage
Commission my0 2ozz
PIANS VEGETATION SEATURTLE MANGROVE
REVIEW I REVIEW REVIEW REVIEW