HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE
Date:
BE COMPLIrt - _i FOR APPLICATION TO BE ACCEPTED ,_? ' . y�
Permit Number:
Building Permit
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
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I ryl 1-R.i `• i
MAY 112020
Permitting Depi irtrnent
.St:.L,ucie ggmnty, FL
I PERMIT APPLICATION FOR: I
Address: ?5//O C .11946.-.-
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name:
Project Name:
i
Setbacks Front 3 Back: Right Side::3/, / Left Side:
Block No.
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=QETAILED,DESC(;1RT(ON
Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
LeElectHc _Plumbing _Sprinklers _Generator V Roof �tch
Total Sq. Ft of Construction:
Cost of Construction: $ t164 llali
'Sq. Ft. of First Floor: _
Utilities: _Sewer ✓Septic
Building Height:
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GOI�TI�AETOR�
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Name G1 -1
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Name a �'
Address:
City: Z-71 Alrwc State:
Address: 1 �� G �u 1 eZs
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City: /=1.(
State: !�
Zip Code: Fax:
Phone No. —
Zip Code: J !�l.�% Fax: —
Phone No 77�
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E-Mail: 7`di17 Z"J16- em
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Fill in fee simple Title Holder on next page (if different
E-Mail a l-cY7c
State or Coun� e G�/_1%
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from the Owner listed above)
If value of construction is 75uu or more, 3 KPLUKueu wonce ar
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
_
Address: cS �?E• /�1
a .
Address:
City: F.! Piu
tate:
City:
State:
Zip: 3y9S"D Phone >'77-you-77S i
Zip:
Phone:
FEE SIMPLE TITLEHOLDER:
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
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 rriay'resultin 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 vour Notice of Commencement.
Signatu a of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
E OF /
FLORIDA n� /� (3
STATE OF ORIDA
OUTNTY OF e-+c
OUNTY OF
The for ng instrument was acknowledged before me
2day
The forgoing instrument was acknowledged before me
this of 20 2ZCby
this _ day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signatur of ry Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Know Z—OR Produced Identification
Personally Known OR Produced Identification
pe of I entiftcation
Type of Identification
Produced -- ,,,
Produced
....:, UrMPHNADELFINADANZIQUE
MYSION # GG 915982
Commission No. + `` M
Commission No. (Seal)
EX eptember23,2023
' R;f`8•' Bonded Thru Notary DuNkUndenMters
.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
EIVEDEPLETED
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Kev. 7/ZU14