HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO
�,MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: LOW I7 Permit Number:
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Building Permit Application
Planning and
and
elopment RegulaionDices t'-inp „ es peri27)r .owo-i%p�"/c)
Building and Code Regulation Division (�(.��'r-`'
2300 Virginia Avenue, Fort Pierce FL 34982 ✓
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: -it
5-S-/ oZ
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722i e D12 d is
Legal Description:
i n pia
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2 359 i --
Property Tax ID #: * -3 `I D a ce O 3 0 / / kT o o Lot No.
Site Plan Name:
Project Name: i n
Setbacks Front Back:
.ewto v
f Right Side: /6' Left Side:
S
Block No.
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Additional worK to ne pertormea under tnis permit-cnecK aii tnat appiy:
_Mechanical _Gas Tank _Gas Piping _Shutter`s _Windows/Doors
_ Electric _ Plumbing' _ Sprinklers _,Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq _ Ft. of First Floor:
Cost of Construction:$* J5, Utilities: _Sewer _Septic Building Height:
Name ! T�)oro:wf
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Address00(o
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City: FT
Pi e/"ce—
State: Ed
Zip Code:® U qA-2_ Fax:
Phone No.#
`2 7,;t • a-6/ ^ p- b' /
E-Mail: ®
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Compa
City:
Zip Code: . Fax:
Phone No
E-Mail
State or County License
State:_
wJ
If value of construction Is 2500 or more, a RECORDED Notice`of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:® T)ov% . /lueI(P
Address:W R-r S Lcnive,-sr*r Bv. soy
City: oti�Tr[pi 1 r r State: IPl
Zip: � 44sR Phone &L,(- ta,;za> lm � -7.5-
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Address: I Address:
City: I 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
cnmmencing work or recording vour Notice of Commencement.
�S gnatureoftOWZer/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OFTLORIDA
COUNTY OF
COUNTY OF
The fo oing ins ent was acknowledged before
�dayo
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% �r �
The forgoing instrument was acknowledged before me
this 2077.by
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Cd�..
this_dayof 0_by
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'Dow , M' F N
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(Name of pers n acknowledging)
m
(Name of person ackno edging )
Signature o t ry Public- State of lorida
(Signature of otary Public- State of Florida )
Persona y Kn wn OR Produced Identification
Personal) Known OR Produced Identification
Type of Identifi ion
Type of Identification
Produced
Produced
Commission (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
5
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
`
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DATE
COMPLETED
Rev. 7/2014 SIRWI�