HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
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 Residential
PERMIT APPLICATION FOR:
Address: l q ?Y( Aq Ut k
Legal Description: I O c l< I 3! 3 Y 1l/ 1dq F r �¢- Y6
PropertyTaxID#: 3cJ( -0 ( 0jo—dao'S— Lot No.
Site Plan Name: S ° irI t ( - Block No.
Project Name: , f
Setbacks Front Back: Right Side: Left Side:
���t►7 � ll�7^�L� � ��aa■■r�.
Mechanical Gas Tank —Gas Piping _ Shutters _ Windows/Doors
Electric ` Plumbing —Sprinklers _ Generator Roof Pitch
Totai Sq. Ft of Construction: Sq. Ft. of First Floor: f
Cost of Construction: $ . 9-YO Utilities: —Sewer —Septic Building Height:
w
-77
Name LucfA l Name: �—�sr�' . ✓eft
Address: r Company: t V1 v4c-f , (i/mixyot #`crtr
City: e i__State: ' Address: 0 CI-vcale- Y'd
Zip Code: 3 1651 -- Fax: �L% - City: Fiw t State:�L
Phone No. i"'3� Zip CodeFax:��'i C
E-Mail: Phone No
Fill in fee simple Title Holder on next page if different E-Mail . ( €- t
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from the Owner listed above) State or Cou4y License .
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
[ON
DESIGNER%ENGINEER: Not Applicable (MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address- Address.
City._ - _._ State- City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable BONDING COMPANY; Not Applicable
Name: lo, I'l il a,- door, Name:
Address: `t Address:
City: M k q t'VL I L City:
Zip: ).(a_--e 20hone: 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 pornit, 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,
accessary 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. [f you intend to obtain financing, consult with lender or an attorney before
commet*inR work or recording your Notice of Commencement.
ature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA �
COUNTY OF Ll,{
The forgoing instrument was acknowledged before me
this 3 day of 20_ZZ by
PX3�__n
(Name of person acknowledging)
(Signature of Notary Public -State of Florida j
Personally Known OR Produced Identification
Type of Identification
Produced
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Signature of Contractor/License Holder
STATE OF FLORIDA� U
COUNTY OF -
The forgoing Instru ent was acknowledged before me
this t3 l day of allAkn20 ZZ:by `.
D � 0,JwJ64-Z-_-
pa;�Vl 0
(Name of person acknowledging)
1311ZZ
tggnature of Notary Public- State of F€`orida }
Personally Known Z-" OR Produced Identification
Type of Identification
ced
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REVIEWS COUNTER ZONING VIEW I SUPERVISOR REVIEW , REVIEW
DATE
RECEIVED
DATE
COMPLETED
VEGETATION I SEA TURTLE I MANGRO
REVIEW REVIEW REVIEW