HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLI CAB4E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEF 1
Date: 1 Permit Number.1'q I (
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 _z
APPLICATIONPERMIT FOR:
Address: �Y/ 03 R�� (Opr-' I—T) Ppo
Legal Description: tDf 53r7. Nn)ic ac/ �nes su�dil�ist`yn hasp �� �CCoc01la! tDfh�_ P(o'i-
PropertyTaxlD#: IJI,-l'—�)U6,1,`ylU
Site Plan Name:
Project Name:
i
Setbacks Front Back: .01 Right Side: l 3 Left Side:
Tonal work to be pertormed under this permit— cneCk a
Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Lot No. 5WO
Block No.
apply:
_Shutters _Windows/Doors
Generator Roof Pitch
Total Sq. Ft of Construction: I / Sq. Ft. of First Floor:
Cost of Construction: $ OU Cry ~�)tilities: Sewer _ Septic Building Height:
1i1 nrl n i Y f n% c L '�- r-[ . Thn i - _
OW N,ER/LE=�SSEE:
C.t�NTRA.CT,�O�R
Name
Address: �-ii 0`� i�eo�lc�o _Df Company:
City: Ert tCf CP State:
Zip Code: ,39' Fax:
Phone No. A2V 3 — J 0 S" 10-0 3
Name: --
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail: i-y-\knY-Y-\*yyy-\iti'\y I'y\at1 ,CDrn
Fill in fee simple Title Holder:on next page ( if different
from the Owner listed above)
E-Mail
State County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU '
PLEM NTA!_ ITS
NSTI4N1.
CI Lt N LAW !
FOR TICi ..;
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _'Not Applicable
Name:
Address:
Address:
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.
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 orand 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
commencing work or reco trRyour- �ice-of.Commencement.
Sig tu' of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
���,�'�,
STATE OF FLORIDA
COUNTY OF ��
COUNTY OF
Thd f oing instr nt was acknowledged -before me
this � day �Z� 20y
The forgoing instrument was acknowledged before me
day
of
this of 20_ by
z
(Name of person acknowledging ) �—
L� J64—M 11 ,
(Name of person acknowledging)
(Signature of N,1_1Lry Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificat o ,
Type of Identification
Pr M OF
Produced
�9 ,. o os Notary'Public -State of Florida
T1PaY PGBIiL i
Cd, ' s ' °� . .commission # FF 234730 eal)
Commission No.. (Seal) '
_
?� * z My Comm. Expires may 27, Zu-
Notary Assn.
Ronded through National
REVIEWS
FRONT
ZONING.
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW'
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.