HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1q0T-0/3C-
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: .
Address:
Legal Description:
Property Tax ID #:
M
f
—I I 'if 'IF 1, -
Lot No. f 11
Site Plan Name: E7*7-kTW-< � Block No.
Project Name:
Setbacks Front- -7;70**"' Back: Right Side: Left Side:
amonaiworKtOoeperTormea unaertnis permit- cnec
&-'Mechanical Gas Tank Gas Piping
electric VPlumbing ZSprinklers
Total So. Ft of Construction:
Cost of Construction: $
all that apply:
Winj - oor
—Shutters: s:;
Generator &--Roof Pitch
Sq. Ft. of First Floor:
Utilities: ZSewer _Septic Building Height:
WN 11 R, I @ R �
LOWNTIRMAN
Name
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Addresg�
I*'1111C
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Apan -1 1.- " 641�
Wo M6S
City *04 State.
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Address:4i�t-�e
Zip Code ` Fax
0,41v)
F;A� LVA- State:
Phond b'
de
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Fax: ti
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E-Mail:✓
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Fill in fee simple Ae Holder on next page if
from the Owner listed above)
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414;541'Al,
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If value of construction is 2500 or more, a RECORDED Notice Cf Commencement is required.
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P � ENT `I. CQNSTR�iJGTli3N LIEN }I'Nf{JR
ATtON.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _
Not Applicable
Name�7AJ6
Name:
Address: f -T-51 L404WDQQ
Addres : � ,G 9R1*- 'Ex.6
City:=ff Pam( S State: -Pi
City: (X
State: N
Zip: 3 90:1 Phone Z5.9 ,' -j6 P �S" A
Zip: 1[00 2-2- Phone:ZAz
e3
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY:
Not Applicable
_
Name-e fr_V-1Lc 6" -pen i% I
Name:
Address: P�u7e; FPAcfle%'Pz� [.cam
Address:
City: 01g VAUi t'SGtj.,,
City:
Zip: Phon
zip:.t Phone: 4 -3P._J`7X
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtainfa 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-. sidential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in r paying twice for
improvements to your property. Notice of Commencement must be recorded a posted o e jobsite
before the first inspection. I Inte obtain financirI co suit with lende ran atto ey before
p g,
commencing work or re ing y otce of Comme ent.
Signatur of n esse /Contrac s Agent for Owner
gn�•ur f ntrac r/ 'cense H er
ATE LORIDA
TE F F RI
COUNTY OF PALM
COU
The forgoing instrument was acknowledged before me
C
T going instr ent as acknowledged -before me
's
this day of 0 CTo t EtZ . 20A by
t day of 20 l lby
tt_FtA a t'k lvtkK kl s
(Name of person acknowledging)
(Name of person acknowledging) .
(Signature of N tary Public- State of Florida)
(Signature of Notary Public- State :of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification r
Produced rL p1ZWErZ Lie-stAS II1////
Type of Identificat
Produced 1--
`�,1111
ON
Commission No. �� �� I15 �••'1N/��
�sommission No, '�"�''. HAIiPVq IN
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COMPLETED
Rev. 7/2014 - " • •! • • •