HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Hate: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residentiai �C
PERMIT APPLICATION FOR:
Address: .'L f-((�-M Cil C
Legal Description: cS L i_ C4e �4
(may Y
Property Tax ID #: -35' �� C
Site Plan Name: 547 4 M (3-A
Project Name:
Setbacks Front Back:
4q
Right Side
C
cal'' 6//tf C4rLCz
Lot No.
Block No.
Left Side:
AaOmonai worK to oe perrormea unaer tnis permit- cneCK all Mat apply:
_Mechanical — Gas Tank Gas Piping _ Shutters
— Electric — Plumbing ` Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
d
Cost of Construction: $ _ J3 7f Utilities: _ Sewer _ Septic
Name (14lj,, i9�h cl i2d
Addres?s: 1, c n
City: �` f- _ s L State: _
Zip Code: .�15_ Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: i'C'Jrri
Company:JKfK
City: F�f - State:-.
Zip Code: 3 LfiFax: =1 f
Phone No_�7-�f
E-Mail V_ c� Ii
State or Cou y License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Applica
Name: � -
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address.
City. State:
Zip: Phone:
BONDING COMPANY: —Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: ARplication 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 ti
which is in conflict with any applicable Hom
structure. Please consult with your Home D
In consideration of the granting of this requ
in accordance with the approved plans, the
The following building permit applications a
accessory structures, swimming pools, fenca
t is granting a permit will authorize the permit holder to build the subject structure
Owners Association rules, bylaws or and covenants that may restrict or prohibit such
ners Association and review your deed for any restrictions which may apply.
.ted permit, I do hereby agree that I will, in all respects, perform the work
orida Building Codes and St. Lucie County Amendments.
exempt from undergoing a full concurrency review: room additions,
walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure tq Record a Notice of Commencement may result in your paying twice for
improvements to your property. AN tice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you inted to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of CommPnfPmpnt
Si nature of owner/ Lessee/Contractor as
gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF-
The forgoing instrument was acknowledge
this f
before me
The forgoing instrument was acknowledged before me
y 20r�L
by
this __�3 day of et .0 20,E ( b Y .
(Name of person a wledging)
ry
(Name of p on cknowledging )
(Signature of otary Public- State of Florid�ntification
)
(Sign ure of Notary Public- State of Florida
Personally Known
oduced)
OR PrId
Personally Known OR Produced Identification
catEon
Type of Identification
Produced
Type of Identification r —
Pr aced
Commission NO C�� . z�, �
DEANNAM GERNA
.� My GOMMIssION. #GG2
JUN 26, 2
mission No. Pig UEANNA M GERHAR?
�n SaIMISSION #GG23225
2 EXPIRES' JUN 26, 2022
EXPIRES'-
1st State I
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urance !�6onoeC through 1st State Insuran
REVIEWS
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VEGETATION
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MANGROVE
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REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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