HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE t
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-
PERMIT APPLICATION FOR:
Address: i'
Legal Description: l S,
FOR APPLICATION TO BE ACCEPTED
Permit Number;
Property Tax ID #: 1,� EC .S 667' 6PY
Site Plan Name: �p 4 ti I i L
Project Name:
Setbacks Front Back:
n
Building Permit Application
Commercial Residential
610
Right Side: Left Side:
C;
Lot No.T !,
Block No.�
itiona wor to a per Vane un er'this permit - check all that apply:
Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers T Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ r� `7�J d Utilities: —Sewer _Septic Building Height:
Name Acn ti r-t� ( �/�'I l-1111t.11
Name-
Company: V€ t ec� lh d/v� ('✓t4
Address:
City: �� T- I v
State• �
+fit
Address: U c 1�
City: �t �?; _- _ State:IE-
Zip Code: -3 Z - Fax: 6
Phone No
E-Mail�'�=li
State or Cou y License
Zip Code: `� Fax:
Phone No. 5
E-Mail:
Fill in fee simple Title Holder on next p
from the Owner listed above)
ge ( if different
If value of construction is 2500 or more, a RkCORDED Notice of Commencement is regwrea.
�
,.
^TGAGE
DESIGNERIENGINEER,
Not Applicable
pp
COMPANY:
R
MO.
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: Ar piication is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has corr menced 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 HomeOwners 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 requellsted 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 ar'e exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fence, 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 your Notice of Commencement,.
"4�
Signature of Owner/ Lessee/Contractor as
Agent for Owner
Signature of Contractor/License Holde
STATE OF FLORIDA
fi.
STATE OF FLORIDA
S'
COUNTY OF f
COUNTY OF�
The for oing instrume t wa packnowledge
this � da of LL U 20_Af
before me
by
The forgoing instrument was acknowledged before me
this day of 20i54! by61
1�1Y�Ge JA
'
G
2-mac
(Nam f person cknow ledging)
(Name of p on lcnowledging )
f t s
( ure of Notary Public- State of Florid
)
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Id
ntification
Personally Known OR Produced Identification_
Type of Identific
Produced �=
ape of Identification— .
Produced LE �� L . . ._ .�
C �
ISS1CK #GG23
_ i]EANNA M GERHAR
255 '_"" PRY p��84
h Y COMMISSION #GG23
CO No.
Commission NO. ?� q
11YCCSJtM
Ey,PIRRs ]UN 26.2a2
mission a, a EXPIRES: JUN 2B, 202
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thrnu9n 5S 5.ate tins
ance t ! cn,v^"� Borden through 1st State Ins
Banded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/20 Z4
14