HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLEX.-.-._ FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: /-7O(0 - V3 ` r
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 Y
PERMIT APPLICATION FOR:
Address: / 06 40 60 . 009EIMA1 d 2.. ttLOO 8 3TA 3t'-q JeWdlZ-L 3
c
Legal Description:— --(zsAvJ,t ' oJ4 g aO-w-S
PropertyTaxlD#:���+��%.Ol��'�Y Lot No.
Site Plan Name:
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
Block No.
Mechanical Gas Tank _ Gas Piping _ Shutters Windows/Doers"
Electric 3C Plumbing Sprinklers Generator A'IZoof" � Pitch
C �'•i:, 'i'� :i:'i,�,� c rijiy'i ? 4i�1:•r.liTSlti:i:.7 r(.`.
Total Sq. Ft of Construction: 3b r
Cost of Construction: $ � 600 , a o
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name pfeJiGEjUEPYO ` TOSL' 60AJOAyr7
Addres§:.,69 roAt CA—
W
City: E e t� G� U State: NT
Zip Code: 0 9 9A0 Fax:
Phone No. 72,A
E-Mail: dal rovo ® W)'lenTz .:f
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: / l ( t°C
Company: J ✓S o li .f�- C. t e L,
Address 07 3 p-fA v.M e C
City: L L L State: G
Zip Code: 3 4 q 5 Fax:
Phone No `1 z 3`( 0 � 6
E-Mail F0 a ez,—A1c ►'� e
State or County License C&C. L �
If value of construction is 2500 or more, a RECORDED Notice of Commencement is regwrea.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: , _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:'
BONDING COMPANY: Not Applicable
Name:
n •d.d.,,,.,.
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 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 roi ms 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
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Signature of Ow er/ Lessee Contractor as Agen --for Owner
Signature of ontractor/Lic a Holder
,ENS�
STATE OFMOMBAr
STATE OF FLORIDA ,
COUNTY O M l M- -S&
CI UNTY OF 2kll.�a�
The f r cing inst um nt 6vas acknowledged before me
n�day' �%
The forgoing instrumen was acknowledged before me
day 20J2 by
phis of� !. `L�1/ , 20 % by
this of
- •0 a
I
(Name,of riT Alit R
NOT RY..PUBLIC OF NEW JERSEY
(Name of person acknowledging)
My Commission Expires March 28, 2018
"
(Signature of Notary Public- State of•Ia)
Silgnature of Notary Public- Sta of Florida)
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OR Produced Identification
Personally Known OR Produced Identification
Personally Known
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No.. _ (Seal)
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DATE
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Rev. 7/2014