HomeMy WebLinkAboutBLDG PERMIT APPLICATION DOMESECK 3All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ Permit Number:
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: V 614.
Legal Description:
Property Tax ID #: �r 6) /4t Lot No.�
_ Site Plan Name: Block No.
Project Name: — lLj .�r� �� L
Setbacks Front Back: Right Side: Left Side:
C1STROTi01NFC�fRMA310N:
:.
itiona wor to e pe orme under this permit- check all that app y:
Mechanical_ GZPlumbing
as Tank —Gas Piping `Shutters windows/Doors
Electric _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Building Height:
? 3 s71
Q71(ERLEF -
O NTI�i�C1'f3
-
Name vrx o c, • _ L,-vq s AeL ...;
Name: ,--
Address: -e.
City: T State: f-L
Zip Code: 1-3 Yf J16 Fax:
Phone No. -77 1 - f, -
Company:
Address:
City:
Zip Code: Z—
Phone No —V&-�^'
State:-Z
Fax:
4;2S-C
E-Mail: ' i
Fill in fee simple Title older on next page ( if different
from the Owner listed above)
E-Mail ��^ 4'
/fir '
State or County License
4! /? C�
If value of construction is Z500 or more, a Kt:LUKUtU rjoiice of t,ommencemenr IS requerCu.
SUPPLEMENTAL CONSTRUCTION LiEN LAW INFORMATION:
EER: Not
Name:
Address:
City: State:
Zip: 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:
vvvimM/ LVIV I KALI OR 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 It;SPROVEMENTS TO YOUR rROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SiTE BEFORE THE FPRST INSPECTION. IF YOU INTEND TO OBTAIN FIRIANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of fawner/
Owner I Signature of Contractor/License Holder
STATE OF FLORIDA '' J STATE OF FLORIDA
COUNTY OF l ht U COUNTY OF . I AIU
The forgoing instrqment was acknowledged) before me
the day of 20 flL by
Name of person making
A
s6tement.
Personally Known OR Produced Identification
Type of Identification
Produced
f f
(Signat re of Notary Public- St
% n aV�`C'tyJ Notary Pubitc State of Ftonot
Commission No. r `I {f S�{1�jy5 sa L Butterfield( k7yL'ammimon GG 302065
'?„«pet xpues 02(14t2023 I
The forgoing instr ent was acknowledged before me
this-�—dayof��1.�' 20c2/ by
Zbfr� 0 -n
Name of person making Cement.
,r
Personally Known Vim' OR Produced Identification
Type of Identification
re of Notary Public- State of
ion No. :'O") ice' �_
�ot�y..lpfK�
eal) 1e sa L dv e'
V1.1 }y rn-ss -.GG
r1 a- nn> 1211<2W3
CODUNTER REEVIEW SREVIEWOR I REVIEW I VRE EWUN SREVEW E PREVIEW