HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COxc_ . t ETED FOR APPLICATION TO BE ACCEPTS
Date:
Planning and Development Services
Building and Code Regulation Division
- 2300-Virginia Avenue, Fort -Pierce FC34982 -
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number: �U0 0�
Building Permit Application /
Commercial Residential
PERM Iri4PPLICATION FOR: J)t C.0
Address:
Legal Description:
Property Tax ID #: i a-'
2—
Lot No.
Site Plan Name: ) / ) Block No.
Project Name: / K le /
Setbacks Front Back: 16' Right Side: Left Side:
Additional work to be pertormed under this permit- cnecK all tnat apply:
_Mechanical _ Gas Tank _ Gas Piping Shutterst- ; _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: �j �'ZJ a/ �• Sq. Ft. of First Floor; .
Cost of Construction: $ j( •� Utilities: _ Sewer _ Septic Building Height:
Name'_-AdAV_(./ +-
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City: State: H
Zip Code: 3L(`9$z Fax:
Phone No. 77Z- Zoq-9_3b5
E-Mail: -VagitE X,[hrJ /30 r!i •t''Dr/4
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:�Sm _
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.
I
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DESIGNER/ENGINEER:
Name: rr QC,�"i3� iG
Not Applicable
ineeriv li- es+(
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: dS S' .
Address:
City:
. Statg
City: State:
Zip: - Phone
I
I
Zip: Phone:
FEE SIMPLE.TITLE HOLDER:
_ Not Ape licable
BONDING COMPANY: _Not Applicable
Name:
Name:
-Address:
-4
Address:- -
City:
I
City:
Zip:. Phone:
Zip: Phone: I
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 gra ting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owner 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 per . it,"I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida B ilding Codes and St. Lucie County Amendments.
The following building permit applications'are exemp from undergoing a full.concurrency review: room additions,
accessory structures, swimming pools, fences, walls, igns, screen rooms and-accessory-uses,to.another non-residential use
WARNING TO OWNER: Your failure to Recordla Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be.reccirded 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 vour Notice of Commencement.
\t
C)PI alj_"
Signa repo"".f,:Owner/_Lessee/Contraacctor as AgentI
r
Signature of Contractor/License Holder
STATE OF FLORI
=
STATE OF FLORIDA
COUNTY OF�
COUNTYOFThe
for oing instru t was acknowledge efo
'
The forgoing instrument was acknowledged before me
this day o x1 20 / by
this day of , 20_ by
+ l�� V2
(Name of person acknowledging)
ei <
(Name of person acknowledging)
(Signature of Not Public- State of Florida)
(Signature of .NotaryPublic-'State of Florida )
Personally wn OR Produced Identificatio
Personally Known OR Produced Identification
Type of Identifi It
Type of Identification
Produced k C
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REV
EW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I
4-k/
RECEIVED
DATE
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COMPLETED
Rev. 7/2014