HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a Permit Number:
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: as
Address: yo/i rue
Legal Description:,/b
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Building Permit Applicati n SEP 2 9 2029
ST. Lucie County, Permitting
Commercial Residential �-
I? 99
�S 5.6.373�' W 1,60 (47s
Property Tax ID #: d3al? 60100 fs' MO 7
Site Plan Name: � ,�' %%G �lli�g-
Project Name: Setbacks Front Back: Right Side: Left Side: .5Y `?
Lot No. 3(0^ �d
Block No.
Additional work to be pertormecl under tnis. permit— cnecK all tnat apply:
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: �7 / 'Sq. Ft. of First Floor: c52 qI 5 7 �7
Cost of Construction: $ J�sB�% Utilities: —Sewer —Septic Building Height:
17, u y S
Name`: .Sf% C. � h
Address: % �i
City: ' State: 2-4--4—
Zip Coae 'W.q9 - "Fax:' ., ,r�ao ��w %
Phone No. 272 ?D/ -P3
Company:-,.4.-
Address:
City:. State:
Zip Code: Fax:
Phone No
E-Mail: k `�� �9'�� 3'3 -,tgled
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
1f value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ 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 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 recordin our Notice of Commencement.
Signatur�,_pf Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA. —
-COUNTY OF L U C (e
STATE OF FLORIDA
COUNTY OF
The for ng instrument was acknowledged before me'
this day of 2070 by
The forgoing instrument wgs acknowledged before me
this day of _ 20—Wby
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature 6Y Notary Public- State of Flori )
(Signature of No ry Public- State of Florida )
Commission No. a9Fiarlds
Commission No. 'i Notary duets of Florida
My Commission GG 292585
ms o2H 1
. ' Keryn G Drawdy
My Commission GG 292565
PLANS
VEGETATIO
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MMITILA
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.