HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMFLc i fD FOR APPLICATION TO BE ACCEPTED
Date: 3. `i (0�C)� Permit Number: 1;z003- DaS
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-15.53 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address* /y0e
Legal Description:
I
Site Plan Name:
Project Name:
Setbacks Front Back:
0
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Building Permit Applicati' Is1p1p
eyn� Pnt
Commercial Residential
Right Side: Left Side:
_Mechanical _Gas Tank _Gas Piping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Potal:Sq,-Ft.of_Constructaor): S/,0i
n0
a3st Eonstructiom-szOe0
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Marne 2d o 2
Name:
IA(ddress:/962 40 M Lr , ./Jo-.
Company:
t
C��IIity:%Ql�rie: State:,EL
zip Code:�/f6Z Fax:
i
No. %)2 Z/6 d'jiyF
Address:
City: State:
Zip Code: Fax:
No.
JP.,pine
Mai1Phone
EUin fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
IT vame or construction is ZSUU or more, a RECURDED Notice at 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
bylaws that may restrict or such
which is in conflict with any applicable Home Owners Association rules, or and covenants prohibit ,
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
commencingwork or recordingour Notice of Commencement.
Af
(Signature•of--Owner gent/ Lessee/Contractor
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 5 L l Gt
COUNTY OF
The forgoing instru ent a cknowledged before me
a,
The forgoing instrument was acknowledged before me
this day of 20
this _day of 20_ by
^ �� o�y
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary lic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commissi FI N VAUGI(fNal)
Commission No. (Seal)
` o,Y
gio` °4',State of Florida -Notary Public
' Commission # GG 270 779
„n�°
REVIEW
y o
Octo
er22 2022
PERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.