HomeMy WebLinkAboutBUILDING PERMITALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �®.._ �� -!
Permit Number:
Building Permit ADDHCation
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
Property Tax !D #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Rep Ltw 50 ��llO ,
& ncc `fie
L]HVAC Gas Tank
11 Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ /S_ 011z_
"ION:
under iIs permit - c ec a app y:
❑Gas Piping _ Shutters
OSprinkiers ❑ Generator
S Ft. of First Floor: _
Utilities:[]Sewer Septic
Y_
Lot No. /05-
Block No.
Windows/Doors
Roof Roof pitch
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name ""
Address:
Name:
Company:
City: "o ��L_°� State: '
Zip Code: Fax:
Addr s: �. _
V6 _ `t
yt_" �1 /C iLG rt
City: s i - ''
i�E` State: le�f.-
Phone No. 772 - F � ` 1- '1
Zip Code: 9`� -
Fax: %�� ® ) ,_ j 2
E-Mail:
Phone No. ) Z .2
E-Mail: 14 ^ 4y' i ey) m'l
- _3"�-�--
/LsL-rz
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: C-
N2 Y Y-3-5-
If valna of rune+- .'+*._n � taenn ..- Y___ _ nr........-.. .
__ - - __ .___. _, - ... _ vvnn uc111.vf11C11L 1b VUEJUIre4.
DESIGNER/ENGINEER: Not Applicable `
MORTGAGE COMPANY: Not Applicable
Name:
Name: '—
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: .e Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
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 firs inspection. If you ' tend to obtain financing, consult with ender or an atta y before
commencin ork or recordin ur Notice of Commen>naof
Si nature of wnerJ gent] essee/Contractor
ontractor/Lice- Holder
STATE OF FLORIDA
COUNTY OF 5+.Wac-
STATE OF FLORIDA
COUNTY OF -G,+ . l"df
The forgoing instrument w s acknowledged before me
The forgoing instrument was acknowledged before me
this day of -_ cy-1-110tw— 20, t by
this ZI day of - 0Q-_ 2Q1 `i by
(Name of person acknowledging)
(Name of person acknowledging)
re of Notary Public- State of Florida }
a ure of Notary Public- State of Florida }
Personally Known OR Produced Identification
Personally Known OR Produced Identification f/
Type of identification
Produced �L
L DtARY,q NOSID BECKTARY
Type of Identification
Produced J::1� � ly SID BECK
NO PUBLIC
STATE FLORIDAl
Commission No. r GG145988
r NOTARY PUBLI
commission No. 0 1 STATE OF FL O
I
Expires 9/25/2021
.sN , Coernn# GG1459
8
1 Expires 9/25/2
2
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