HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLE'i'mi FOR APPLICATION TO BE ACCEPTED
Date: ' ' l , 0 Permit Number: rl ox, 0 1 q
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AUG
.- Building Permit Application PERT filialI4G
Planning and Development Services St, t_ucie County, IF
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT A.. O.
s
Address: /2//5 Sc)(AtA161dIAN R i i/L:R 0t,-iV
1 �IQs�G► 6�mGrl
Legal Description: r i lla jg 6 �e.
PropertyTax ID #: ,L.- 001 'f✓ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
/v L -rpklo 9f)(2*P r
Right Side:
71
Left Side:
Block No.
ditional worK to be pertormed under trus permit— cnecK all tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ ShuttersWindows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator /Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _�'S00 0D
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LE�S�SEE:
C®NiRAC`i # R:
Nam .S f
Address: t 11 S� S
('VCL
Name:
Company:
City: j &A s V_ H A A exGA State: &
Zip Code:;7 Fax:
Phone No. - 0 69
/
E-mail:fA&,e_S G v weA L.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
PL EN? L� Co ME U.CTI �, LICt1 W I' ''F MATI4
DESIGNER/ENGINEER: _ INot Applicable
Name: I
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address: I
City: I State:
Zip: Phone I
I
FEE SIMPLE TITLE HOLDER: _ �Vot Applicable
Name: I
BONDING COMPANY: Not Applicable
Name:
Address: I
City: !
Zip: Phone: I
I
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:
I certify that no work or installation has c
plication is hereby made to obtain a permit to do the work and installation as indicated.
menced 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 Hon, e 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
improvements to your property. A
before the first inspection. If you in
commencing work or recording yoi
to Record a Notice of Commencement may result in your paying twice for
4otice of Commencement must be recorded and posted on the jobsite
:end to obtain financing, consult with lender or an attorney before
r Notice of Commencement.
f
Signature of Owner/ Lessee ontractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF .
COUNTY OF
The fo going instr ent was acknowledged before me
this day of 20 by
The forgoing instrument was acknowledged before me
this day of 20_ by
ey en I _
i pro two
(Name of person acknowledging) `
(Name of person acknowledging)
. I
(Signature of Notary Public- State of Fli rida)
(Signature of Notary Public- State of Florida )
/
Personally Known OR Produced Identification V
Personally Known OR Produced Identification
Type of Iden i ' ation I
T o Identification
Produced �"`aY�"a�n, KAREN S. NI
LO uc
* Commission # FF
1 15637
RE *'
Commission No. �, �) My Commission
N(�drrli ion No. (Seal)
June 12, 2
18
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIiEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
!
Q�
COMPLETED
Rev. 1