HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a� Permit Number:
4
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 C011lfllet C181 Residential X
PERMIT APPLICATION FOR __j;2..00
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Legal Description: s ane c n kL-. rt �Z'A .`n�Dom` `y -A- ALA,
Property Tax ID #: �� �.r� LotNo.
� �� Block No.
Site Plan Name:
Project Name: �0►C }"►�r1
Setbacks Front Back: Right Side: Left Side:
DETAitED .
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CO /` i►iNG t]
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Additional wor to be pertormed un er t is permit— cneCK all Indt a[Jpy:
❑HVAC 7 Gas Tank F]Gas Piping _ Shutters ❑Windows/Doors
ElElectric 7 Plumbing Sprinklers lJ Generator ® Roof Roof pitch
Total Sq. Ft of Construction:1C S.Ft.( of First Floor:
Cost of Construction: $ 135d b b Utilities: L—Sewer Septic Building Height:
Name
Address:
City: q
Zip Code.- �i 1f Fax:
Phone No._VYZ .- " d,4 - lo9Q (F
E -Mail
State:IA4
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Q0&j1yny4puS
Company-.--
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Address: %%4vs;-
�ity-State_
Zip Code: ��9 F=1 Fa.–An"a--q-S _ (y�
Phone No.
E -Mail- i
State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: k Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
City:
Address:
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..
holder an mayd the subjectru t such
prstructure
St. Lucie County makes no representation that is granting a permit will authorize r and permit
which is in conflict with any applicable Home Owners Association rules,
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 pians, 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 inspectio u intend to obtain financing, consult with .lender attorney before
commencingwork or re ordin ou otice of Commencement.
Sign re of 0 ner ontractor as ent or Owner
Sig ture of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF �11�
STATE OF FLORIDA//,,,,4,
COUNTY OFti
The fo going instrump t was acknowledged before me
this, day of /A& - 2,0� by
The for oing instrument was acknowledged before me
this day of 7Au . 1.20,2()by
}9
�—jrIS�C�fn�
Name of person making statement
Personally Known k, OR Produced Identification
Type of Identification
Produced
Name of person making statement
Personally Known x OR Produced Identification
Type of Identification
Produced
Je—;7 _/_ d' – --
J}Kenny
01 (Signature of N ary Pu fP',
ZL� /I
(Signature of N ry P i- t t I i
mmission GG298597
Commission No.aw ���t 0/2023
MI'NM�11V�+y
N Notary i to of Florida
Commission No. I �s'� Sandra
My Commission GG 296597
Expires 01/30/2023
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17