HomeMy WebLinkAboutBuilding Permit All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: r,/f �2a Permit Number: gbh - b Jt'
Building Permit Application '41 d 'J
Planning and Development Services
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Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: Ac C-"2-
Legal Description: ct`m 07-t'o V-P S I
Property Tax ID#: 3�/0 - SO 3-D �' ��� Lot No.___�_1_^
Site Plan Name:_ !1J / �} Block No.
Project Name: wt ) k
Setbacks Front Back: Right Side: Left Side:
I�dGYjo2, 6 Blit of XeCe.-al)dfn
Additional work to be pertormed. un er this permit-check all that appy:
_Mechanical —Gas Tank _Gas Piping Shutters _Windows/Doors
—Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
of
Cost of,Construction:`$1110,S Z Utilities: -.Sewer i Septic Building Height: d2
Name�o— - --- - Name: A
-Address: b , f' `Com an C a"it, d'i1 f crj fp
City: e re-e State:�l~' Address:~ Z �
Zip Code: `3 Fax: City: eAr'e State:
Phone y y o .$'$'31 Zip Code: 319=/ Fax: 1�2- cf'�.!F
No.
E-Mail: Phone No 9?,Z
Fill in fee simple Title.Holder on next page(if different E-Mai! TQ H?, Tky i L ,w�VX/10d. C'_^I
from the Owner listed above) State or County License CCeJ,3j/9ZL0I
If value of construction is 2560 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:
OW'NER/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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants 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
imprciv* ements 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
commencin&Work or recording your Notice of Commencement.
Signature of owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License.Holder
STATE CIFFLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF .......... tA)r—VF
The fo[going instr t was acknowledged before me The forgoing instruQ9t as acknowledged before me
this 15 day of H Dh L 20Z7 by this day oft. ___,20-2
,Q by
--r#DUAS
Name of person making statement. Name of person making statement,
Personally Known OR Produced Identification L_� Personally Known OR Produced Identification
Type of Iden *fi Type of Identification
.y ication
Produced V-1VI-k\04 D a I V6(- U e*tGc, Produced RX,6A VeAtsv_
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"nature of Nkotary Pubfiq-`Stat2221F da f Notary ft6iie-St4jg�iPlorida 'ei
I gnature o �zo.\y
<ZP 9-
Commission No. .0, '07
vc mission No.
REVIEWS FRONT VISOR PLANS VEGETATION NGROV
!qQUNTER Fr o EVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE,
COMPLETED
872117