HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
as. �
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:
r
Address:
Legal Description:
/c/ FA
f'i T a7 J� d i'10 K -4->e-- I f- C tLsr W Cam.
Property Tax ID #: I ✓� �� " 5 C�f� �� - �� 3 -- —
Site Plan Name:
Project Name: n
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No. �7d
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing Sprinklers ` Generator
Total Sq. Ft of Construction: d & _— Sq. Ft. of First Floor:
a
Cost of Construction: 6d Utilities: —Sewer _Septic
Name `[ L-m 4c
Address:
City: �2 State:
Zip Code: -3 C S Fax: �I7 --
Phone No. °7
E-Mail:
Fill in fee simple Title Holder on next page: ( if different
from the Owner listed above)
Name: 'V
Company;
Roof Pitch
Building Height:
OF
'M f
City: Fry R � Stater.
Zip Code: Fax:
Phone No
E-Mail. C-Qi `
State or Cou y License_ l
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
MIA
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: lAddrC55:
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: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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
ir tcture. Please consult with pyour Hlome Owners Associawners tion and reviebylaws ur deed for any restrictions s that Which marestricty applyibit such
In consideration of the granting of this requested permit, I do her agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and 5t. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, femes, walls, signs, screen rooms and accessory uses to anther 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
cornme iZkor recording our Notice of Commencement.
Sit nature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA S4 }L, •
COUNTY OF
The forgoing instrument was acknowledged before me
this_ day of :act nYl1-I&KU 20Z 7-by
Pa)'V, & b 0
(Name of person acknowledging)
(Signature of 4Qotary Public State of Florida }
Personally Known V-"OR Produced Identifi tion
Type of Identification
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this -IL clay of r� 20 ZZby
-J
(Name of person acknowledging)
dL �- i- 9/ -tea. a.
{Signature of Notary PuV
ate of Florida }
Personally Known Produced I entification
Type of Identificatio
ri uuuL.cu t -� HASShA S/tiASAIA
?� � r' Notar Public - State of F;orioa i
+lY� •�: Commission o �'
Commission; N ,M ° Ca6tssiln = GG 3aC327
nF r..:My Comm, Ex]ves it;; 28. 2023
60rdeC throtigh National notary Assn,
REVIEW$ FRONT ZONING SUPERVISOR I PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
A4ABR1A
Notary Pub4i- . Sate of Florida
qar` Cammi5sior
-MyEor,m, tx�uesJul 29. 2023
gorged Ihrotgh Natioral Notary Assn.
SEATURTLE { MANGROVE
REVIEW I REVIEW