HomeMy WebLinkAboutBuilding Permit ApplicationJ '�f
ALL APPLIICABLLEI INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: r7kv L/./ _0Lfzfo
Building Permit Application RECE1�6o
Planning and Development Services MAR
Building and Code Regulation Division ent
2300 Virginia Avenue, Fort Pierce FL 34982 P rmittl u9 a ea�AW
Phone:(772)462-iSS3 Fax:(772)462-1578 Commercial ResidentiaPSt.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
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Site Plan Name:
Project Name: pt-Ki •
Setbacks Front' Back:
Right Side: SO' Left Side: —WL—
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Lot No. b valp
Block No.';1__1
HVAC OGasTank ❑Gas Piping I shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator 1:1 Roof
Total Sq. Ft of Construction: MI '1� Sq. Ft. of First Floor:
Cost of ConsriW—m"? S-7 I (pDO Utilities: 0Sewer OSeptic Building Height:
Name
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Address: 1W
City: �I \i (CA State::E _
Zip Code: _ SLIQ TS2- Fax:
Phone No._1-19- GL ib' ILA%j
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City: _ N (' � `A I DI
Zip Code: -3qq4_0 Fax:
Phone
State:��
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:() j
State or County License: owl
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUC`i`ION"LIEN LAIN INFORMATION;
DESIGNER/ENGINEER:
N a m e: M. R/+NDALL ROGERS
Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address: 1801 HAZELWOOD DRIVE
Address:
City: FORT PIERCE
Zip: aosaz Phone�Tz-Zel-l6aa
State: F�
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencin work or recordingour Notice of Commencement.
ev. Nolary Public Sl2 e • -
ATh0 asina Bowins .Y
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STATE OF FLO I A pp
STATE OF FLORIDA
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COUNTY OF
COUNTY OF EUa
The f going instrum n was acknowledged before me
� day rF�.�r c� 20� by
The f oing instrument was acknowledged efore me
� ffl(�,I�iX1
this of .
this day of . 20y
TERRY WIX
TERRY WI%
Name of person making statement.
Name of person making statement.
Personally Known _ C OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED