HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit 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
PERMIT APPLICATION FOR:
Address: C
Legal Description:
Residential jC
3 �J 9" ,-
Property Tax ID#: 2 �4 i`''( — �u " C1Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical
Electric _
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Tank
Plumbing
Gas Piping
Sprinklers
SHLftters
Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name kJ1k r .''4-1L 3 AJ 4 aJ Y'e
Address: (oO 2�
City: _ / A L`_ C*F State:
Zip Code: '34 1 L(_ - Fax:
Phone No.!Q --?2J 90
E-Mail: � L�{� ��;�.�1t u Q 1ti— r
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Pitch
Name: r4)✓cam r .4' & to u i �67 U,
Company: 1 OkAlt, t7t'C ;t4'C 4d Ate-,
Address: 3 0) 1 /` Lu 14
City: C State: —EL
Zip Code: S Fax:
Phone Nod -112-i 3__( --1- 914 1 �
E-Mail F
State or dounty License tail 13 OL3Q67
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
_ Not Applicable
I►T,[0 iCl_LCM6I*1T lZLVA
Name: Name:_
Address: Address:
City: State: City:
Zip: Phone Zip:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:_
Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:_
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
commencing work or recording vour Notice of Commencement.
Signature of
r as Agent for Owner I Signature of
er
STATE OF FLORID / STATE OF FLORIDA j
COUNTY OF /) L-1 �= ° COUNTY OF <'4' t U(_"" e
The forgoing instru ent was ac nowledged before me
this ZQQday of q c' 20>6 by
(Ngme ofierson acknowledgi
(Signature of Notary Public- StatoAFl
� S
Personally Known OR Produ
Type of Identification
Produced
Commission No.�=� Z
a)
Identification
JOSE FRESNII
State of Florida-Notai
aCommission # GG
IIMy Commission E
December 22, 2
The forgoing instruny nt was acknowledged before me
this • day, of Q S; 1- 20 Eby
Ppmmf Identification
-trod ed o"�v'd'a 6JOSE FRESNILLO
Public lfSState of I'loride-Notary Public
2 47 �� Com{�i-s-s4�n # GO 272747
�Sn ssion No. � ° ° My =iaslon Expires
t2 „' December 22, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014