HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETE FOR APPLICATION TO BE ACCEPTED t�
Date: Permit Number:1�0
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BUilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 r
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 1
Legal Description: lG �.rxa� /'�rZ--
Property Tax ID#:J, 4 l-" Lot No.
Site Plan Name: . Block No. 9J
Project Name:
Setbacks Front Back: 3. 6 Right Side: Left Side:
Q AI E DSCRIPI'® ' F CAR
CONS .RIJCTlD�J I�('F0 A Id'N•
Additional work to,be pertormed under this permit-check all that apply:
—Mechanical Gas Tank _YGas Piping —Shutters _W ndows/Doors
—Electric Plumbing,. —Sprinklers —Generator _Roof Pitch
Total Sq. Ftof Construction' Sq. Ft.of First Floor:
Cost of Construction:$ /L 0�c d� Utilities: _,Se.wer. Septic Building Height:
canlTRp�ro., . .
Name •.' Name:
Address: 30 Company:� � _
7 .
City: t::, �err. State: L Address: 6_1� Cry 4q
Zip Code: Fax: City: `� Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No r x O
Fill in fee simple Title Holder on next page(if differerit E-Mail GCa le !
from the Owner listed above) State or County License
value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
.0 BE i C ,N 6 11 MAT1 ,
DESIGNER/ENGINEER: , _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone 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 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
commencing work or.recording yo Noiice of Commencement.
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Signature of O 'r/Lessee/Contractor as Agent for Owner Signature of C rector/License Hokfer
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'SAr. L-0 c COUNTY OF SA .
The f rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of O%t c\% ,20a by this day of A A_%N 20A by
Sara c Zckc N-t �' Cans\S-�o!PinsV C A4-it C
(Name of person ac nowledging) (Name of person acknowledging)
7� __Sx��11
(Signature of Notary Pu c-State of Florida) (Signature of Notary Pu ic-State of Florida)
Personally Known Personally Known OR Produced Identification
Type of Identificatio DEANNAMAR Type of Identific
NMIProduced L = MYcoMCiISSION#GG Produced 1+ra
pPcember 16,2u10
=02 ry Public ilndervnitor., Y CO lE GNENS
ndedThruNote MMISSION���CCC��op�p2�023
Commission No. Commission No. IRES:Decerrtbeeb'�
°•' Bonde Thru Note U2t)
ry PubUc Undervniters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED L I�
DATE
COMPLETED
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