HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 \�
,�,, ; fm g� ``a� rPermit Number:
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NOV 17 7017
B Ming -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
PERMIT APPLICATION FOR: p
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Address
WAIIII'MIJ
Residential
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Legal Description: �OT 1-2y e IQS 15r11J RLP^e L \ Sec7cr,
Property Tax ID #: `� Via' S01— 01�1^1' d�i0 Lot No. 1 9
Site Plan Name:
Project Name:
Setbacks Front Back:' Right Side: P� ` Left Side:
nal worK to oe pertormea unaer tnis permit— cnecK a
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: 42-6
J "Q
Generator
Sq. Ft. of First Floor:
Block.No.
— Windows/Doors
Roof Pitch
Cost of Construction: $ / �) C)0 ' Utilities: _ Sewer _ Septic Building Height:
Name '��CoTfi 6 7
Address: Q i a y !tied PS ? l v
City: —"�OCJSG'k eeeedk State:_EL
Zip Code: 3 � Ff7 Fax:
Phone No. q/qr & 7 7 —Iq5Z,
E-Mail: SevT'CYoTe, i @- 1 � GbCti
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: c?
Company:
Address:
City: State:
Zip Code:
Phone No
E-Mail
State or County License
Fax:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ _ Not Applic le
Name: '�14w,,� t, 5 )e,Vit
Address:3ao a �- C zwPivu s sit aw
City: V-1 brQ c(,, (�qfde_W S State: F
Zip: _3 J 41 f) 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 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 permit, 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,
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 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
commencingwork or recording your Notice of Commencement.
�wi/�-
r
Sign ure of Owner/ Lessee/Contractor as A t for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S)r,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this l day of QOA 2011 by
this day of 20_ by
(Name of person acknowleclng)
(Name of person acknowledging )
(Signature of Notary Pu ic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced O NA-L d
Produced
NAMAR1EGIVENS
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Commission No. Mf 4s10N#CG02202i
Commission No. (Seal)
"x FXpIRES: Decernter 46, 2020
'>r•. •'c' ded Thnt Notary public underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
�l I
DATE
COMPLETED
Rev. 7/2014
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