HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE
Date:
FOR APPLICATION TO BE ACCEPTED
;,Permit —,Number, AW ��Co
R_ ECE'1VED
0CT 2 62021... J_
Building Permit ApplicationPe°min,g"ry
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: 7>D6 (.,
Address:
Residential 110"7
Legal Description: 73 V' 4/4 Al/ a�/1/�1J��dF�ly��.s��DF�4J �yL1ASSWIpD
Property Tax ID #: f%d 7 - �j G!>/.S• DOD • Lot No.
Site Plan Name: Block No.. -
Project Name: 404F S.d
Setbacks Front Back: Right Side: Left Side:
wo
rtnis permit -
-Mechanical _ Gas -Tank Gas Piping
LElectric :.! lumbing _ Sprinklers
apply. ..
_ Shutters _ Windows/Doors
_ Generator,
Total Sq. Ft of Construction: �%�� Sq. Ft. of First Floor:
Cost of Construction: $ CS .l Utilities: —Sewer —Septic
Name
Address:
City: Fr ic/ / State:
Zip Code: % 7 9417 Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
_ Roof
Building Height:
Name:--AO0C3A-'K=/ lJ
Company: OQ
Address.ZQOQ
City: z2r - 0 1 e iLG ' I Stater
Zip Code:,3!1q�2 �-i Fax: 69—/0i'o3
Phone No
E-Mail D d If
State or:County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNE N NEER• ; of pplicable
Name*
Address:
City: M /' State, _l
Zip:J V V 8' 7, Phone -
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 ermit 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 yourflome Owners.Associatio'n and;review your deedsfor.any restrictions which may apply.
In consideration, of the granting of this requested, permit, I.do hereby agree that I will, inall:respects, perform the'work
in accordance with the+approved,plans",the Fjo'r'ida,B6ilding,Codes,and,5tu Lucie -County gmendmentsr
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 mayre'sult•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 ,len_ de_ r or an attorney before
commencing work or recordine vour Notice of Commencement. iV.
Signatu of Owner/ Agent/ Lessee/Contractor
Signature of Contractor/L.Ghse Holder
STATE OF FLOR /-
STATE'OF FLORI /
COUNTY OF Zl
`COUNTY OF /c- '�-�
The fo ling instrument was acknowled ed before me
this day of Q �•% . 2W by
The fqr g instrument was acknowledged before me
this ay of _Ajr.:r , 202/ by
Jowle-s-
"-A 6��7_ B Y' I ZZ
(Name of perso acknowle
(Name person a nowledging )
(Si ure of Notary Pu '/1- of Florida)
_E110ature of No c= State of Florida)
Personally Known OR Pr viced Identification
Personally Known OR Produced Identification
Type of Identification .:o•: HERRhFEH.MM
Type of Identification
�mmisslon#GG187160
Produced
Produced 2o�Y?,B`^ SHERRIFEHLMAM
. g Expires March 14, 2022
and fiNaud9e�NomryServkea
Commission'# GG �87160
@F@�l
Commission.No. (gea
Q i14,,2022
Commission."No. 't ' �o E xp t( .
'- OF,f1. `'BatWadilWBudpO�Not2ryS0f1'ips
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE'.. ,
;MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW '
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014