HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date:
Permit Number: pLAU
Building Permit Application �«
Planning and Development Services
Building and Code Regulation Division C" /41G
23DD Virginia Avenue, Fort Pierce FL 34982.�-
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: c2q/A live.
Legal Description: 0 L)n r
FT Pig
MA
Property Tax ID #: �qgP5-sDi-- 664pL(^Dego - J Lot No. 1_
Site Plan Name: Block No. I
Project Name:
Setbacks Front Back: Right Side: Left Side:
ditional work to be pertormea under tnls permit- cnec
_Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction: C t 5 g r
Cost of Construction: $ 445 Dfl ` 01
all that apply:
_Shutters �_W/indows/Doors
Generator R�,oof Pitch
Sq. Ft. of First Floor: 3 q1
Utilities: _Sewer y/5eptic Building Height:
Name ftaro'e-4- _S6n(60.4S
Address: �S� �o 5� 0640- .
City: N%P ro 8 eGtclx State:
Zip Code: �3,) Ot&-7 Fax:
Phone No. i7Z- S�� �1 - !� -7-7 Ql
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: (I j-f T)O
Company: tda(t.,1
Address: D Ad
City: Stater
Zip Code: Fax:
Phone No-45-L - to Yq- %ZL'A
E-Mai}_
State or County License U t, 13 a 7 2-0-9
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CE+�NSTRUCTIDN LI'E LAW I'NFORMATIQN:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
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
is in Home bylaws
which conflict with any applicable Owners Association rules, 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
commencing work or recording our Notice of Commencement.
L
,LO
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder,
STATE OF FLORIDA
COUNTY OF�-�?�
STATE OF FLORID "
COUNTY OF !� /
T�
i�
The forgoing instru ent was acknowledged before me
this' ay of 71 2011 by
The for of instrumey�t was acknowledged before me
this alley � 20tJ by
.. rA:L
of
(Name of person acknowledging)
1�")'
(Name of person acknowledging )
a'4." '�4
—
ignatur of No ary Pu lic- 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
�cw RUFUSALEXANDER III
ro uce
MY COMMISSION # FF 054161
Commission No. (.% WOES: December 20,2017
ommission No. (Seal)
Bonded Thru Notary Public Underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014