HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLET'r.`v r`OR APPLICATION TO BE ACCEPTED
Date: 5 ar5 Permit.Number:
RECEIVED MAY 2 5 2017
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: -07 D
Legal Description:
Property Tax ID #: ��9 - �Q�, - 060S '666 I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks' Front Back: Right Side: Left Side:
Haaitionai worK to De perrormea unaer finis permit — cnecK aii inai apply:
_Mechanical _ Gas Tank ' ", _Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing —.Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction:,. L Sq. Ft. of First Floor:
Cost of Construction: $ A in , � Utilities: —Sewer —.Septic Building Height:
t
OWNS /LE=�S� EE:
CO TRACTOR:
Na' rrre
Name
Company.
;Address �_'" t)�
City: State.
Address:%
Zip Code','3 9 ?X Fax:
City: N ero e0. State
Phone No.
Zip Code: �q(� Fax: S�D`1"O 11q
Phone No
E-Mail:
Fill in fee simple Title Holder.on next page ( if different
E-Mail rUa mo al ' 'Co t-fi
from the Owner listed above)
State or County License e d 9. . s
V value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
i
St1PPLEMEN � CO STREI�T'
�N L��N LAW !N
�QRMATl4 �`
DESIGNER/ENGINEER:
Name:
Address:
City:
Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
I
City:
I
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 granting a permit will, authorize the permit holder to build the subject structure
which is in conflict with any applicable Home 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 �re 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. A 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 vo4 Notice of Commencement.
Signature of Owner/ Lessee/Corit`ractor as Agent for Owner .;sign re of Contractor/License Holder
STATE OF FLOg1DA STATE OF FLOTIDA
COUNTY OF L COUNTY OF \,I" .QA� j _e_1
The f ing instr nt was acknowledge before me The forgoing instrument was acknowledg d before me
thi day of E 20 by this day of 20]L by
� lJr d�J
(Name of person acknowledging) (Name9.f person acknowledging)
Notary Public- State of Florida )
Personally Known V
Type of Identification
Produced
BondedThru
Commission No.
IRE M. ESTOCK
;SION N FF 238495
October 5, 2019
vy Public UnderwMers
1k
(Signa re of Notary Public
Personally Known O
Type of Identification
Produced
Commission No.
of Florida )
MARGUERITE M. ESTOCK
Y COMMISSION # FF 238495
XPIRES:.October 5, 2019
kd ggffitary Public Underwriters
REVIEWS FRONT ZONIN9 , SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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