HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.-
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone.- (x`72 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: TS J68
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Legal Description: F1,,1\,)()
Proper tyTax ID#-.- Lot No.
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
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CC1NS7RUCTiPN INFORMATION.
Add'iti'on'alwoFktobe ertormed under this permit - check alltbal-apply:
LNHVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof I .] Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 5), 00 0C),
17
Sc:. Ft. of First Floor:
utilities: Sewer _ Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR.
N a m e
I
Na.- k, )4 ax
Address: 51�,Oi S)n r)
Company: ac SC Y (C 1 4LC,
city: State:,�&
Address: 5 k)�L) �..a-rem+j �e, ... � i
Zip Code: 3Y C15 i Fax:
City: Poe-4 �4-, J -u c ke State:
Phone No.-�a .r �
Zip Code: 3q -:31sil
E -Mail:
Phone No. 1'/Z-- %'71 -15W
fill in feesimple Title Holder on next page if different
E -Mail: it -40 1. ).ce CC, ten
from the Owner listed above)
State or County License:
it value of construction is!ZWU or more,, a RECORDED Notice of Commencement is required.
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FEE SIMPLE TITLE HOLDER. Not AppUcable
Name.
Address#'
City:
Zip: I P h on e
BONDING COMPANY: .__ Not Applicable
Name:
Address.,
city,.—
Zip:
Phoney
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 Count makes applicablemakes no reresentation that isgranting a permit will authorize the permit holder to build the subject structure
which Is in conflictwith any 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 accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result In your paying Wce for
improvements to your property. A Notice of Commencement must be recorded and posted on the jo site
before the first inspection. If you 'intend to obtain financing, consult with lender or an attorney before
cornmenciniz w–o& or record i nf,-Y—ou r Notice of Commenceme
)57
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signaturt/of Contractor/License Holder
STATE OF FLORIDAp STATE OF FLORIDA
6 + Le�,
COUNTY OF t I COUNTY OF
The forgoing instrument was acknowledged before me
this day of L�,k, _ by
26
Name of person making statement
Personally Known X OR Produced Identification
Type of Identification
Produced
L
,iSignature of Nlt�Gry -Public- State of Florida
Daniel 906496
RE\/T%T!7 FRONT ZONING
I COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing Instrument was acknoWedge before me
this :3 day of C1 -AJ 20 by
-
64
Name of person making statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary PublifL` State of Florida
SUPERVISOR I PLANS -
REVIEW REVIEW
Not" pt"o St9s, of FWda
Michelle Daniel
My Commission FF 906496
EG�TATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW