HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IG I I Permit Number: O
- Building Permit Application
'�Eh'!'JII3�'f i 3Ca
Planning and Development Services St. r
Building and Code Regulation Division _uc"' { ounty, FL
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#:'
Site Plan Name:
Project Name:
Setbacks Front Back:
Totdl Scl.'ftCc
i ,!J P
Cost of,c6rrs
i I�
Right Side:
Side:
5nutiers
;Generator
c -
x
Et. of;First Floor:
x
"Sewer i Septic
♦�I a
Lot No._
Block No.
Windows/Doors
Roof
Building Height:
O '*Ni , R LESSEE:
Name?; r'
alne
Address , X. ���'a,
Company:- I
City,:. _ State:
Address:
Zip Code: Fax:
City: .1
--�r1
Phone No. 17120 00 - LO I I
Zip Code:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail �� o �,
State or County License 0cC lezk • rl
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
4 1 `' k-y 1 c-
UPPLEU1f T l CC1n1, ``U N Lt LAVC( N
V
"ORP i1Q ,
DESIGNER/ENGINEER: _ Not Applicable
Name: Al 14
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
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 ill 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 ieview 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 underi
accessory structures, swimming pools, fences, walls, signs, screen i
WARNING TO OWNER: Your failure to Record a Notice of
improvements to your property. A Notice of CommencE
before the firg inspection. If you intend to obtain finan,
comrmencing6ork or recording vour Notice of Commer
Owner/
as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The fgrgoing instrument was acknowledged efore me
this _!I— day of um 20 f , by
ame of person acknowledging)
ing a full concurrency review: room additions,
oms and accessory uses to another non-residential use
ommencement may result in your paying twice for
nent must be recorded and posted on the jobsite
ng, consult with lender or an attorney before
of
'ATE OF FLORIDA�
)UNTY OF
ii s!rng nstru � is acknowledgedefore me
day ofJJ0
by
of Berson acknowledging)
(Signs` Me of Notary Public- State of Florida)
(Sigure of Notary Public- State of Florida)
In 3 I
ecsola lly Known OR Produced Ident fit8m 2
parsoaally Known OR Produced Ident iC1trP`U '
Type of Identific is on
o =
Type of Identification
w W
Produced
o
Produced
IS w�
Commission No. (Seal
oab?I
w a
/n�..
Commission No. G 5 (Se
N
N� p
I)�
r
I
REVIEWS'�� ,,
NG
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
ra
SEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED