HomeMy WebLinkAboutNettles Island A Condo - app formAll APPLICABLE INFO MAST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
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:
I Description:
Permit Number:
Building PerrlhL� Appkatoon
-, -� —
Property Tax ID #: . �5c2l41 — -7
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _Plumbing _ Sprinklers _ Generator ✓ Roof fr � Pitch
Total Sq. Ft of Construction: i -q �� Sq. Ft. of First Floor:
Cost of Construction: $ —L I SC-SICUtilities: —Sewer —Septic Building Height:
Name
Addr:!�42ff
City: State:
Zip Code: S 7 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: T,
Company:
Address: &C -`
City: _ L-w r. State: .-
Zip Code: "-1 _73 ; Fax:
Phone No -7 7,-a
E-MailrfJca�, ,
State or County License L < r C 5�_-7:4T_
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
ESIGNERIENGI
Applica_._
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
v vu Julmn/ 1.vre 1 MA4161 UK A"IUVI I : 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
commencinia work or recording our Notice of Commencement.
Signature of ner Lessee/Contract r s Agent for Owner 5igna ure of Co actor/License Holder
STATE OF FLORIDA ; STATE OF FLORIDA
COUNTYOF COUNT` OF
The forgoing instrume was acknowledged before me The f r��i gg instrumen was acknowledged before me
this �'�day of 20,d by thisX-'�ay of G 20vo by
(Name of person acknowledging) (Name of pers n acknowledging)
(Signature of Notary Public- State of Florida) (Signature of Notary Public- ate of Florida )
Personally Known t/ OR Produced Identification Personally Known L-"'*" OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No.'56(P :0, (Seal) Commission No. 30 J,z (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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