HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Num(
• ^N
1
I
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: M A -
Legal Description:
Building. Permit Applicatii"n
Commercial Residential . A
Property Tax lD #: •��� " o`,�> �"0�®% Lot No.
Site Plan Name: Block No..
Project Name: 3y _f;J2T'N-
Setbacks Front Back: Right Side:. 'Left Side:
Additional worK to be pertormea under tnis permit — cnecK all tnat apply:
_Mechanical _ Gas Tank _ Gas Piping „ ' — Shutters Windows/Doors.,_, .
_ Electric. _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: q. /� 8 S Ft. of First,Floor:
Cost of Construction: $ Utilities: Sewer _Septic Building Height:
Name �� E.c� C.kif Gl+`fi �y ,��,dl_1 Name: ' Yce_c So c�..I P_A_i H 0LQ AJc c /, Su
Address: Ua qo Mr— �.►��Tv Company: p L0-,0e/L
City: fiT ?+ o� C< State:' Address: y/z 4 4-&C7 !Z ofZ C�
Zip Code: Fax: q6D � 7 �4 City: TX t� i C& C r Stater
Phone No. LA& & p c/ 1 I Zip Code: 3 V 9 7 9 Fax: 0 7 7 7Se/
E-Mail: ►25 Plu LSrPa9 13ci/ SouTiyo �ll� Phone No. 041/1 eci/ 0/14 2-
Fill in fee simple Title Holder on next page ( if different E-Mail: C i2S�w�r��/�Soifi�.
from the Owner. listed above) State or County License:
�I If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. I
44
DESIGNER/ENGINEER: = Not pie MORTGAGE COMPANY:. Not Applicable
Name: rL o Name:
Address: ,:/ S fe,D H w Address:
City: QA'v d 4 L'�. c- c.hl State:, f 1 City: State:
Zip: Phone: JT. 9s5/ : 6 70.9-x/0 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.woek or installation:has commenced prior.to th ' i*a'n' ce..of.a permit. -
St. Lucie Coun makes no representation that is granting a permit will authorize the ermit- holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 f st inspection If you intend to obtain financing; consult with lender or an attorney before
comm clnork orrecQine v' ur Notice :of Commencement.
Signature of owner/Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA L r
STATE OF FLORIDA
COUNTY OF
COUNTY
The f rgoing instr .. ent was acknowled e b fore me
day of
this 20
y y ,
The forgoing instrument was acknowledged before me
this day of...
(Name of person acknowledging)
(Name of person acknowledging)
O
(Signature of N Public- State of Florida)
(Signature of Notary Public- State of Florida )
rsonall Kn OR Produced Identi i tion
Personally Known OR Produced Identification .
o Identi p ,, r /111
Type of Identification Produced
ZPPY PVQi �;Ti S
rq x
*; MY COMMSS101i # EE 083530
Commission N EXPIRES: April115gd.
Commission No. (Seal)
P,F, Bonded T ru otary Public Under�nters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/20114