HomeMy WebLinkAboutBuilding permit appAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,Z 017_ _ Permit Number:
C C3 LJ II'11�4 T
r s UN
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description: Ca 1 2 aC
Building Permit Application
Property Tax ID /' rfS` Q 0 d G -d4 0
Site Plan Name:
Project Name: Z
Commercial --- - Residential
Setbacks Front Back: Right Side: Left Side:
Lot No.-A�
Block No. .3
—Mechanical — Gas Tank Gas Piping Shutters
4 Windows/Doors
Electric — Plumbing Sprinklers Generator
— Roof Pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 0 V7
Utilities: —Sewer —Septic
Name :cA #-Ct zio k
Address: 3 l
City: e State: f[
Zip Code: Fax-
Phone No. O
E-Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
Name:
Building Height:
Company:4-4pg flw
Address: 6Z 1
City_ t L c State:
Zip Code: 9 �� Fax: . c SV
Phone No
E-Mail 7,OH7 s 7 C Y�LjoO , f'o�,n
State or County Licensed'C
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City;
Lip: Phone:
__X Not Applicable
State:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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
commencin ork or recording our Notice of Commencement.
of Owner Lessee/Contractor as Agent for Owner Signature of Contractor icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF li�'+- COUNTY OF �sk. �uC�I
The forgoing instrument was acknowledged before me
this r; - day of 41 c44S-r 20ZO by
e1�,
Name of person making statement.
The forgoing instrument was acknowledged before me
this p r' day of ks.,,.,`6 20 20 by
Name of person making statement.
Personally Known OR Produced Identification �� Personally Known OR Produced Identification
Type of Identification Type�-i�Y� 4)P.tvEe- ��es� Prod c ide�,ification
Produced
�` Produced I@LOLlO O.: v—
nature of Not g axY"Pub ic- lorid (Si ature of Nota u ic- Stat - lorida �Q 4
�y�pVAZQUEZ �00 yta .�4�,�b;L
Commission No. a!R��a� 5tateofF4o1 / ���V ,�C�kee
P..,,, .. Nat 1g.4,eso 022 Commission No.
�xpl�ey F
_ c' MY Comm• lonai �yota°Y ,..,u� ,,..., � Lo ot<�,�Na
REVIEWS FRONT SUPERVISOR PLANS VEGETATION 5 � Y L�'`a� v MANGROVE
COUNTS REVIEW REVIEW REVIEW REVIEW R " i'E 1iv REVIEW
DATE '
RECEIVED
DATE
COMPLETED