HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �ae��..c `q Permit Number:
w, l M-
2300
Building Permit Applicatio
Planning and Development Services
Building and Code Regulation Division ST.
Virginia Avenue,Fort Pierce FL 34982
Phone:.(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: 1 r
. _.
RR PtJSE® IN ` OV"S
Address:,3`f/tel?ra v✓ Rel•
Legal Description:
Property Tax ID#: qo5 7/5 `Ovl1 Dac' y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE � °PLED D ry�C '(,PTl . N
C A►� u+ L)0)1 ifee- 1 r : 4 i n., ttld i moi,
Additional work to be pertormed under this permit—check all t at app y:
_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: $ $fid° Utilities: _Sewer Septic Building Height:
Name , x' Name: I�� ;��3ley �er�r «o �itoY3 J-'4
Address: G�,fE :(�aa. `'t7�'! Company:
City: lvi �W My.,, .� �� State:_ Address:
Zip Code: l Fax: City: P. 4;erc.e State:
Phone No. 31,1,1) — Zip Code: 3q 1 i/1 Fax: `
E-Mail: N Phone No 297- 21� " 2Z 92 ;, 116 -G9$?/
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License_
Evalue 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: _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 the permit 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 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
commencing work or recording our Notice of Commencement.
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF .S+z
The forgoing instryment was acknowledged before me The forgoing instrument was acknowledged before me
thi ( day of J LA n e., 20��by thiday of _: U V-'� 20 II_ by
Name of person making statement. Name of person making statement.
Personally Known 1/ OR Produced Identification Personally Known 1-� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatur - (Signature o -
,p�sr Notary Public State of Flori
Commissi N Bonnie L Starling Notary Public State of Florida
10110 GG2292�ea1) Commissio' CA BonnieLStarling ( eal
ja n E>�ires oe/1712022 My �SSwll GG 22929
orw E �yo6H712022
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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