HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COM.'�`,.n!ED FOR APPLICATION TO BE ACCEPTED
Date: 9LIlao—l-el 'r, Permit Number: % l'
`1 'y i'^'y v a' �,y� �'ty� r►N IS V-1^]�!�/�.RA —'^+ I
- I Uin Pert 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: q% 9 `%rpon EI at's , D Ni�trc G 34 9'-/9
Legal Description: �-4 LA2(2 o0- 0= ,n-}c., SO i ot'o 3L-1 75pafk
"VMM•.Mo
Property Tax ID #: _� '� +,? P, �x �='� ��--- Lot No.
Site Plan Name: Block No..
Project Name: t �clr� �( a-1-
Setbacks Front Back: Right Side: Left Side:
ionai worK to oe. pertormed under this permit- chec
Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
_Shutters _ Windows/Doors
Generator _ Roof
Sq. Ft. of First Floor:
Cost of Construction: $ b�C{po,o. Utilities: _ Sewer _ Septic Building Height:
Name 1'A Tyr, Tla{s
Address: Q`11
City: ?Al,,,., State: rl.
Zip Code: 3ciS0 Fax:
Phone No. 1 - S?[ -
E-Mail:L-U a
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: �W-t,+, 1
Company: 7cz-,,4 t nw1S. C�c-c�dirn ►. I LG
Address:
City:A�N, . l�n a��F, State: V 1.
Zip Code: 33yS?a. Fax:
Phone No. 11-1G-
E-Mail:
State or County icense: C
IT value or construction is 25UU or more, a RECORDED Notice of Commencement is required.
GINEER: Not
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 -
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation. as indicated.
I certify;that no work orinstallation hat 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.
Inconsideration 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
_,commencog w6rk or recqedingyWr Notice of Commencement.
t
Signature of Owner/ Agent/. L ssee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,5r, 4LJe_tF- COUNTY OF S7,' LUC.r 62
The for oing instrument was cknowledg�f�efore me The forgoing instrument,was acknowledg efore me
this day of 20J by this a day of nrv& i k by.
(Name of person acknowledging )
k- . -===z�, �acc �_C_
(Si na re o o ary Public- State of Florida)
Personally Known OR P
Type of Identification Produced: .•`'n
Notary Public -State
Commission NOZZ/1 CT14sN9 A Imy Comm. Expires Aul
°.',qF F;;°;••' Commission # EE 1
(Name of person acknowledging)
� C
(Sig ature of Notary Public- State of Florida )
W"g.Wlly Known I O.R P.-A--11^^y'r-:_*e--- - -
TVoe M Identification Produced
aRV Pv I�
No.
Mary Public - State of ride_
F Comm. Expires Aug 4 015,
Commission # EE 119 9
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE- MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED -'
Rev. ;:;;