HomeMy WebLinkAboutBuilding Permit Application (2)APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
ate: V 160 " 15 Permit Number:
panning and Development Services
wilding and.Code Regulation Division
300 Virginia Avenue, Fort Pierce FL 34982
hone: (772) 462-1553 Fax: (772) 462-1578
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Building Permit Application
Commercial Residential P",
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Property Tax ID #: y32� �� Z -6G �0 - �D �� Lot No. )
Site Plan Name: Block No.
Project Name,:
Setbacks Front Back: Right Side: Left Side:
cs i-1,&11
Additional work to be performed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator ZRoof Pitch
Total Sq. Ft of Construction: G� Sq. Ft. of First Floor: �, ��/0
Cost of Construction: $ 1-/ 410 Utilities: ZSewer _ Septic Building Height:
p_C'w� �'�• "�.. .'�c„,�' �°.�e .. $ .t`:. _c�aa?' au. . .Y. . . L .. 4., .. 3 ..
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Address55`u << c�cA�•r'i Je
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(City: 4r4C State: PIC
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Addre�sss:rtgQb f7T[-a L e-
City: (4 ' /i� p�L� State:%
Zip Code: 3C/9 5-0Fax:
Phone No. 77�- - 2: 5
Zip Code: !C( %c/ 7 Fax:
E-Mail:
Phone No 7, "c(7 -4IC5"--
Fill in fee simple Title Holder on next page (if different
E-Mail �-,� /a5C'Di'1S�/ " "� -cam `<< C>,q
from the Owner listed above)
State or County License J 3
If value of construction is 2500 or more. a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
Name.: -
Add'ress f
City
Zip: Phone
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address --
City:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:...._.:. _., .......M...� .. —
Address:
City: State:
'Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 �estrict.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 inspec ion. If you intend to obtain financing, consult with lender or an attorney before
commencing work oecording your Notice of Commencement.
Signature of O er/ Lessee/contracto as Agent for Owner
Si a re of Contract /License Holder
STATE OF FLORIDAc /s
FLORIDASTATE OF Lk-��
COUNTY OF Jf' r` P_
COUNTY OF
The f rgoing instru ent was a knowledged before me
� day �
The f rgoing instrument,wa acknowledged before me
Y day of U��.2r by
this of C)v 204 by
this . 20_
/
ILI vL 01
e (045,A �L/
(Namd of person ack w dging)
(Name of person acknowledging)
(Sign eu_r0dfNotary Public -:State of Florida,.)
(StKati.Tre of Notary Public- State of Florida )
Personally Known `� d WMIRW
Type of Identification
Produced >w OOVAIISSION#i825M
Personally Known od viwtoww—
Type of Identification
Produced OMMUN88.
PIRES:
Sept 9, 2022
Commission No.'AM
XPIR U_:�,opt 9, 2022
7AW
Commission No. —uWamm
%xv
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev..7/2014