HomeMy WebLinkAboutBuilding Permit Applicationi
All APPLICABLE INFO MUST BE COMPLY i'�D FOR APPLICATION TO BE ACCEPTED
Date: / Permit Number:
[RECoVED
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Applicat on MAY 0 3 21"
Permitting ®epertmer
St. Lucie County/ FL
Commercial Residential
Property Tax ID #: Ci I - &D '-O 11 - O • o
Site Plan Name: W - S G-A-J
Project Name: 5
Setbacks Front . 7� Back: 11 '-?_Right Side: s3 Left Side:
1:. _ i' F
W
Lot No.
Block No.�
Additional work to be pertormed under this permit - check all tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
V Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
//
Total Sq. Ft of Construction: 1 �0 O � -}- Sq. Ft. of First Floor: lJrO
Cost of Construction: $ X01, 010--0 Utilities: —Sewer _Septic Building Height:
Name'4 L 1Z W # I
Name:
Address: . -Ira : erC.e_
Company:
City: State:
Address:
Zip Code: `�Cf�i.S�( Fax:
City: State:
Phone No.!22Z - s-z V- �%s��
Zip Code: Fax:
E-Mail:16o e1 Q-r/;,.i derma. V
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License.'
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
_
Address:
Address:
City: State:
City: State:
Zip: , �• Phone
Zip: Phone:
.FEE'SIMPLE TITLE: HOLDER: ' _ Not Applicable
BONDING COMPANY: Not Applicable
Name:' ;,
Nam Ie:
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 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
commgpcuig-woirk-c�jding your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA a
=w: •
STATE OF..FLORIDA
COUNTY OF r>:
COUNTY OF'
" *,
The forgoing instrument was acknowledge efore
day ' 20 by
The forgoing instrument was acknowledged before me
day
this of
-4 �� it
this of 20_ by
2 AMM
� pla T
r ram^
(Name of person afcknowledging
(Name of person acknowledging)
A
(Signature ofAotary Public- State of ffirida)
(Signature of Notary Public- State of Florida )
Persona OR Produced Identification
Personally Known. OR Produced Identification
Type of I entificati
Type of Identification
Produced
Produced
Commission No. 2 (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014