HomeMy WebLinkAboutBuilding Permit Application 7-17-17All APPLICABLf INFO JUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED O
Date: Permit Number: l l
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
PERMIT A.. FOR:
�._
F3' ® A o • ,.V7
Legal Description:
Property Tax ID #:
Lot No.
Site Plan Name: Block No.
Project Name:-- A
Setbacks Front Back: Right Side: Left Side:
dltional work to oe perrormea , under t
_Mechanical _ Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction: .V�
Cost of Construction: $�['
s permit— cneck aii tnat apply:
_'Gas, Piping _ Shutters doors/Doors
Sprinklers _ Generator _ Roof Pitch
Sq. Ft. of First Floor-
-� Utilities: _ Sewer peptic Building Height: `11:1
Name ,�tiLT
Address:
State:_�V_71_
Zip Code: �g Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
......r,. Y.
Address:N';F C0 -
City: State: �L_
Zip Code:' Fax:
Phone No 71 (."Z—
E-Mail S �L"J•J
State or County License�k:T L �?
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
S' PPIEMEN �CowSTR+tJ�1'fUN C=I A LAIIU INFORMATC'aN:
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
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.add,itions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and'accessory. uses to another rion-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.
Signature o ner/ Lesse /Contract r as Agent for Owner
Signature of Co ractor/License older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF LC JGiv'e�
COUNTY OF _ o'
The for ing instru nt was acknowledge 41_1�efore me
this day of 20 by
The ing instrum t was acknowledge before me
this 14 day of C` 20 y
Hem,,,
�I^
(Name of person ackno ledging )_
(Name of person ack wledging )
(Signature of otary Public- State of Florida) /
(Signs ure of Notaryublic- State of Florida )
Personally K o�,,,,,,lia% O 0ELA M H F�,�Q,, i tion ✓
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Personally-K • w OR Produced Identification
Type of Idefi °'_ ryFub114
Co i s' n # FF 2347
Produced =• +s { z 27, 2019
Type of Ili ,
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Produce�7 :4 LA '�
Bonded through National Notary Assn.
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Not. °
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE~
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014