HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE IN MUS CO 8 MPLETED FOR APPLICATION TO BE ACCEPT�u`
Dater I Permit Number:
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 APPLICATION FOR:
Address: � � d
Legal Description:
Property Tax ID #: y�a �� �`� f n Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
;n 4/t_ ro o yc a -,-a
roo , ' 5 V, V
Aaaitionai worK to De perrormea unaer tnis permit — cnecK aii trial apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: 1 9 JAR
Cost of Construction: $ /5t10. oe
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Windows/Doors
1/ Roof Pitch
Building Height:
UINNERfLESEE"
NameHazma A Aze!r& �
ame. 1 a jir::.4 ft11C.! j 0
Address ,
:,&&5 Al e%ory .ae-
Y
. ' •G
:, : r
Company;
City:26� .1 erCG
State:
Address::" -
Zip Code:.3y fc5 / Fax:
City: State:
Phone No. 7%2 2TR 9 — -3e o?S
Zip Code: Fax:
E-Mail
4444L/.CO.,I
Phone No
E-Mail
Fill in fee simple Title Holder on next pa e ( if different
from the Owner listed above)
State or Cou y License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Appilicable I MORTGAGE COMPANY: ` _ Not Applicable
Name:_
Address:
City: _
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Applicatidn 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*Own Association rules, bylaws or and covenants that may restrict -'or -prohibit such
structure. Please consult with your Home Owners ssociation and review your deed for any restrictions which may apply.
In consideration of the granting of this requested p rmit, 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 exe' pt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wall , signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Rec rd a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice f 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 recordin your Notice of Commencement.
Srgnature of Owner/lessee/Contractor.as Agen for Owner
Signature of Contractor/License Holder .
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �ndltjn Lw
COUNTY OF
The forgoing instrum--ggnt was acknowledged befPre me
The forgoing instrument was acknowledged before me
this 2.3 day of JDf0 bW , 20J-1 b
this day of 20_ by
nna I
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identi ication
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced DIL
Produced
(Signature of N 217v NOFELDER
Notary Public- State of Florida
(Signature of Notary Public- State of Florida )
� Comr��s # FF 940757 ` _
Commission No. '. 4 My COmki. �Z ires Aug 7, 2019
.Commission No. - (Seal)
P �'
�'�°� Bonded through National Notary Assn
_
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE, •,
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
I.
Rev. 8/2/17