HomeMy WebLinkAboutBuilding Permit ApplicationDESIGNE
Name:_
Address:
City:
Zip:
NEER: Not Applicable
Phone
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address.
City:
Zip: Phone:
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 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
c ncing work or recording our Notice of Commencement.
ntractor as Agent for Owner Signaturxi-ef-C67ft—ractor/
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFZ12.6( COUNTY OF
The forgoing instrument was acknowledged before me
this L day of OCAOth-X 20-Qby
me of person acknowledging
The forgoing instrum nt was acknowledged before me
this L"S_ day of 20%4 by
ame of person acknowleTging
(Sign�ure of NotaryPublic- State of Florida) (5ign�Nure of Notary Public- State of Florida
�._./�` ]
Personally Known'`OR Produced Identification Personally Known a' OR Produced Identification
Type of Identification Type of Identification
Produced Produced
OS�Y KIMBERLY MENDEZ 4�- r°r�® ERLY MENDEZ
#2 MY COMM / 3G234874 ? MY COMM { GG234874
Commission No. ) Commission No. `
EXPIRE JUL 04+ 2022 EXPIR 4. 2022
3onded through i st State Insurance ` Bonded through 1 $t State Insurance
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETED
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 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 Residential
PERMIT APPLICATION FOR:
PROPOSED
Address:
Legal Description:
Property Tax ID #: -- –CM
Lot No.�
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: i
/G C�AA41e OU
SFS R_ 1
CONSTRUCTION INFORMATION:
Additional work to be peff5rmed un er this permit — cneCK all tnat appy:
AMechanical _ Gas Tank —Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _,,,_ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $.
Sq. Ft. of First Floor.
Utilities: —Sewer _Septic Building Height:
Name
Address: +h
City W,V0 n State:L
Zip Code: �J �i b —Fax:
Phone No, -M- 22 lv 1�
E -Mail -
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
CONTRACTOR:
Company: lCH es #.- * &
At
Address: g2j;S7" ZOYA C—r
City: Ee44A State:
Zip Code: '9200 Fax:
Phone No_��'
E -Mail sr �I�•G r✓1
State or County License CAtI919100
it value of construction Is 2500 or more, a RECORDED Notice of Commencement is required.