HomeMy WebLinkAboutScanned Image 14All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Number:
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 Commercial Residential_
PERMIT APPLICATION FOR:
Address:
Legal Description: JF 14 -e ) ,T
Property Tax ID #: 3 -,„ro Lot No.
Site Plan Name: ,IEP Block No.
Project Name: GJt C
Setbacks Front Y Back: Right Side: Y Left Side:
Additional work to ape arms Werthis 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:
u
Cost of Construction: $ a Utilities: —Sewer _Septic Building Height:
Name V' C Name:
Address: 410 C- "Aki* e- Company:����1
City: State: Address: 2 r
Zip Code: 3 ..El Fax: A41A City: & State:
Phone No. - 6.2 A -4 -L. -Zip Code: _T %Zj 1 d Fax: . c6 S`
E -Mail: A /4 Phone No_7;�2
Fill in fee simple Title Holder on next page l if different E -Mail rVinl, S V 7 e vaL,sv 'o�,•�
from the Owner listed above) State or County License CC/31%f/,i�,pe
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGN[
Name:_
Address:
City:
ENGINEER: __X Not Applicable
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City.
Zip: Phone:
BONDING COMPANY:
Name:_
Address:
City:_
Zip:
Phone:
Not Applicable
State:
[Not Applicable
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 covenantsthat 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,
accessary 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
commencing work or recording our Notice of Commencement.
re of
ntractor as Agent for Owner I Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF L+.�CLF COUNTY OF_ 'Fl-, L%yaIF
Thef rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this la day of 20Z D b
y
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ide ific tion ,r�,, / Type of Identification
Produced Kopf 0t t LVoZ- tic" t9C ProducedFLVLIpA- D1,J LJ e_ LJ t4W-c_
a5 gnature of NotarSi Pt
Commission No. `-IQI )
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
ev.972
:of Florida }
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lic _ state o4 Florida
Noco mission CCF b26,2„22
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lSigPdture of Notary Ptrblff St �
Commission No. 4f 1 S9 S'4 q
PLANS �
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REVIEW
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JOSEPH E. SMITH, CLERK OF THE CIRCUIT COURT - SAINT LUCIE COUNTY
FILE # 4707630 OR BOOK 4419 PAGE 1724, Recorded 05/14/2020 09:04:34 AM
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