HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (7' ) Permit Number:
A.0,
Ok eYRECEIVED
Building Permit Application ®CT
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: h ek / V i X ':7'L ,
Address:
Legal Description:
GO
Residential
V
- a Mit
Property Tax ID #: 2 y2 �'� �d Z - oa8, 3 — p 0 0-- Lot No.f,//,t &
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: %r Right Side: Left Side:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing •�^_ Sprinklers _ Generator
Total Sq. Ft of Construction:
giow !i�/ 0 Sq. Ft. of First Floor:
Cost of Construction: $ ADT Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
OUVN;ER/LR�sSEE
CC7N RACT®`R:
Name A ,JC �i%r
Address. �Q/jI or" 1%%f�� eGG
Name:
/C C 500
Company: L4✓ li i1'.
City:' Ai 'O-C-e State4jeco
Zip Code: �W 98Z Fax:
Phone No. /
Address: �
&re
City: /�.nnG G
Zip Code: 3yY8Z Fax: �J
Phone No o% "' 2/5-- `773
State:�C1
E-Mail: /E `` 9Q ®N
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail it O M e `G Al hellow
.wso-
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
P
SUPPLEIVIENT, L CONST'R�U TIN i.IEN f.AW
NFO
• MA I,ON: _4
DESIGNE /ENGINEE ': '
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: k.
Name:
Address:
Address: ffU& 41eK V c�.n• 00
City:L�w t'4 /a. 4W
State: 'I-
City: State:
Zip: '3?027 Phone
Wi
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 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 requestedkpermit, I do hereby -agree ihatl 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,
access'ry'structures, swimming pools, fences, walls, signs, screen rooms and -accessory useslo 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' iih`lender' or an. attorney before
commencing work or recording vour Notice of Commencement.
Signature. of Owner/ Le55E
STATE OF FLORIDA Q
COUNTY OF
The forgoing instrum
this L day of—<
S �0 C:1
N�
acknowledged befo Vrr
20 by
a ETA
y�
a
(Name of person acknowledging)
(Signature of otary Public- State of FI rida )
Personally Known OR Produced Identification
Type of Iden ' t'a
.Produced.: -�-
Commission No. (Seal):
Signaure oaf Contrac� t orcense Holder
STATE OF FLORIDA
COUNTY'OF'
The forgoing instru ent was acknowledge btfft
this I day of IRICA 20 % o =
T
(Name of person acknowledging )
l
b~ .
(Signature of o aryPublic--State of Florid
Personally KnoWn OR Produced Identification
Type of Identificat
Produced r �,
Commission No
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE.
`MANGROVE
.COUNTER
REVIEW
--REVIEW
REVIEW,
REVIEW .
= REVIEW
REVIEW
DATE
—RECEIVED,,.—
DATE... -
COMPLETED
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