HomeMy WebLinkAboutBUILDING PERMIT APPLICATION11 APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit number:
Date:
4
7-
COUNTY
F L n R. i t�: A -
Planning and Development Services
Building and Code Regulation Division
2300.Virginia Avenue, Fort pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT TYKE: '(jam C _ 'PUj
Address:
Property Tax I I
Site Plan !Name:
Building Permit Application
Commercial Residential
Lot No.
Block No -
Ad ditional work to be performed under this permit -check all that apply: X Windows/Doors
M�:chanical .,�
Gas Tank Gas Piping Shutters -c-`
Generator hoof Pitch
Electric — Plumbing _ _ Sprinklers
Tot4I Sri. Ft Of COnstr:a tion:
Sq. Ft. of First Floor:
Utilities: Sewer _Septic Building Height,
Cost of Construction: $ J""
--.....� r. �Dame:
r'
{ h'
A'; " ow Company:
Address:
C,tu: State:Address: G _ State:�
City:
Zip Coder K ...._ Fax:,, Fax:a=-'7i��a
Phone No. r %_^� :�-�-�? Zp Code:?7-7 _
i Phone No "7"7 2ti- _S ��70
F,JII in fee simple Title molder on next page ( if different
��m
i -Mail tl a owner listed above) State or County License
If:ualue Of eanstruct:ion is $2500 or more, a RECORDED Notice of Commencement is required.
If value of } VAC is r7,seo or more, a RECORDFD Notice of Commencement is required.
I
DE IGNER ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
Cif-y: State:
City: State:
zi ----- - ---Phone _ ----
Zip: - Phone:
FEF ;,SII11 PLE TITLE HOLDER: _-- Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
j
Address:
Address:
City:
Prone:
Zip: Phone:
i
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as ire Jicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
t. �laci.i: i_oui;tv rr:akc-:; no r epresentation that is granting a permit wiil authorize the permit holder to build the subject structure
I��ict is ;n conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or proh�6it such
tructL.+re, Plus -� consult with your Horne Owners Association and review your deed for any restrictions which may apply:
n coksideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
i
he fi51lo;wing building permit applications are exempt from undergoing a full concurrency review: room additions,
cc.-�s:.-nry struc:t.urf-s, sw mming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
`WAJ4N1iNC; TO OWNER: YOUR FAILURE TO RECORD A NOTICE Of COMMENCEMENT MAY RESULT IN YOUR PAYING
'T.VVICE FOR Rd'PROYUMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
: EaTEID� ON THE 300 SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
M'VdTH YOUR LENDER OR AN ArvORNEY AFORE RECORDoMr. YOUR NOTICE OF COMMENCEMENT."
4SIgnae
Signature of Owner/ Lessee/Contractor as Agent for Owner
of Contractor/Li ense Holder
COUNTY Ob'- _ r_
STATL: OF FLQ
CGi~JNITY OF Jg�
The,'Forgoing irstrwiient was ack;,owleoge-d before me
this day of — 20_ by
i'j"e Forgoing instrument was acknowledged before me
this,_ day of Dec, ZQ.ZL by
I
SUN { xn no Lets
i
_
Namo of person rnaking statement.
Name of person making statement,
tinn!!;iCnc�wr OR Produced Identification
Personafly Known OR Produced Identification
iy p ,03; tae:)tlficat a�z
Prod:ur?d_........_....._._... ._........_._..— -... -
type of identification
I P aced_...._..
P7/1 44,f
(5igrittirE of Notary Public State of Florida i
Signature of Lary Public Late of Florida)
Commissiono. -,__-- —__-- (Seal)
Commission No.PA :< 5;9t ill.@YM.ANTONEW
MY I;OMMISSION # HH 14
2025
!!
REVIEWS FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
: E of Fta.• Baide6VU
Nowy pubiie u
81,91
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RE_4JVEU,
DATE -+