HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C',' _ _:P-LE7E1JJ FOR APPLICATION TO BE ACCEPTED ^^
Date: Permit Number:
pi E
SEC t7
. Permit App
Planning and Development Services P`. -
Building and Code Regulation Division St. Lu.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓
PERMIT APPLICATION FOR:
Address: k�_96 0 1--Z Wi d ?Sda le- G- V/,
Legal Description: Akb � *e C
Property Tax ID #: 113.300 —6 d��' �d 3 y �%�j-� Lot No.
Site Plan Name: Block No.
Project Name: 1l6 /`U r S
Setback# Fronts Back: _3�- Right Side: Left Side:
Additional work to be pertormed under tnis permit- cnecK an tnat apply:
_Mechanical _ Gas Tank —Gas Piping _ _ Shutters
_ Electric _ Plumbing _ Sprinklers _Generator
Total Sq. Ft of Construction
Cost of Construction: $ 4 00 (2
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Windows/Doors;
Roof Pitch
Building Height:
OW ER/LORB; E.
CON R CTQR:
Name *� ).4 So— ����i'ff0�
Name:
Company:
Address:*s-9 (J
City:1/Cl State'-
Address:
Zip Code:Fax:
City: State:
Phone Nd'r(s j/) )L U�--W30
Zip Code: Fax:
Phone No
E-Mail: As Dice
E-Mail
Fill in fee simple Title Hol er on next page ( if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:'
Name: 4W
I Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
I
Address:
City: A
I State. -
City: State:
Zip: Phone
i
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
I
City:
Zip: Phone:
Zip: Phone:
I
OWNER/ CONTRACTOR AFFIC
I certify that no work or installation
St. Lucie County makes no represen-
which is in conflict with any applicat
structure. Please consult with your I
Application is hereby made to obtain a permit to do the work and installation as indicated.
commenced prior to the issuance of a permit.
n that is granting a permit will authorize the permit holder to build the,subject structure
ome Owners Association rules, bylaws or and covenants that may'restri.et or prohibit such
_- Owners Association.and review your deed for any restrictions which may apply.
In consideration of the granting of this �r'equested 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.lA 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 your Notice of Commencement. Al
r nf'`Qwner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoinginstru ent was acknowledged before me
The forgoing instrument was acknowledged before me
this k- day of 1 20C1by
Do� W�Z�� .
this day of 20_ by
-
Name o person making statement. I
Name of person making statement.
Personally Known OR Produced
Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
-
nature of Notary Public State af,F,lorida) LAS1iA1i1'4"
{PnvI��F,.; state of rloaiu,
mature of Nota Public- State of Florida
(" Notary )
Commission No. "t �. min Expires Dec 20.
; 0 i ,
111
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Q. Corilfhlssion � FF 1772
C° mission No. (Seal)
N ac
4fifough National Notary
Assn.
Bonded
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
-
DATE
COMPLETED
ev. I