HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CG'MPLETED FOR APPLICATION TO BE ACCEP'rEu y ,�1 r7 Q
Date: u� 9 Permit Number: I 1 l V
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
PERMIT APPLICATION FOR:
Address:
Legal Description:
Residential 1/
Property Tax ID #: "I 1q — 55 -1 —0ao-0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch .
Total Sq. Ft of Construction: NO 41C Sq. Ft. of First Floor:
I ��ities: Sewer Septic Building Height:
Cost of Construction: $ _ _
Name C ' UL
Address: , 1. Ti_C,!_(_ C+
City: IV)i- }-• LM�_p I State:.
Zip Code: JL10 3 Fax:
Phone No. I w - ,5no1_8 ruor)•
E-Mail: 11nAiP T? (tgL4 Cv 06 ,CM 1
Fill in fee sirt(ple Title Holder on -next page ( if different
from the Owner listed above)
Name:
Company:
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.
3 5%4,W5 �, k +✓ `°¢.: y$,�F,ay "�`
e b o-y l" A 45,E S. " v0
SU; ?PIE i TAI. C(3�STRl1CT[ }N LIEUJ AWW I 5", ATIQh 4
.'• fir: 3.$.r�.iy, .. E.a$ea p:. .a r...;a .'.°,, ak$£ffi
S`
� �
DESIGNER/ENGINEER: _
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:'
I
Address:
City:
State:
City:
State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: I
City: I
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 Dhners 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 permitI 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 c'onctirrency 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 tIo obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
.1
"r- )
Signature of Owner/ Lessee/COO
essee/Co r ctor as for Owner Signature of Contractor/License Holder
r
STATE, OF FLORIDA' STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged befo a me The forgoing instrument was acknowledged before me
this 3Q day of !C) Qk 20 n by this day" of 20_ by
Q� 1�I1f111�lAac.. � "
(Name of per n acknowledging) (Name of person acknowledging)
(Signature of Notary Public- Stak of Florida) (Signature of Notary Public- State of Florida )
PersonallyKnown OR Produced Identific ltion � Personally Known OR"Produced Identification
Y
Type of Identification r, _: r,,-,_ ��ti��._ T�Xpof Identification
Produce dm.�„ „ L SHAHNAINGRAN�Produced
A, ;,1, Notary ublic -State ofFlorida
Commission No. = o (5qeAV)ComT. Expires Dec 2 , .Gor4lission No. (Seal) "
'•,�q� o-e;� Com�ission # FF 177149
........
. ... Bonded throuah National Notai v Assn. iY
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
fI
COMPLETED
rcev. //LU14
.1 -