HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C'-V_iPLETED FOR APPLICATION TO BE ACCEFi"ru
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: Y_4%D _aj
Legal Description:
Permit Number: �� I a - I0�
E MD
1 11�
Building Permit Application DEC 1PER�d;►2' 2017
St. Lucie County, FL
Commercial Residential
,l'-U
Property Tax ID #: 12>q 1 l - SLIE ' Ow • 000�—
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
oitionai worK
_Mechanical
_ Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
permit — cnecK aii tnat apply:
Gas Piping _ Shutters
Sprinklers _ Generator
Sq. Ft. of First Floor: _
Cost of Construction: $ L( 0 0U �. Utilities: —Sewer —Septic
Name &� (/�e_ L. i PJ T
Address: D
City: e State. P_
Zip Code: Fax:
Phone No.—
E-Mail:
Fill in fee simple Title Holder on neAt page ( if different
from the Owner listed above)
Lot No.
Block. No.
Windows/Doors .
Roof Pitch
Building Height:
Company:
Address:.�� l��r'lfJ cf�OfZ/ %Lr/�
City: Pf L State: �'
Zip Code: � % T5 Fax:
Phone No 77 2_ _r2_ — 096
E-Mail ."eMOLII�iGh-c!V,440- Gdm►
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: ' State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: Not Applicable
Name:
Address: .
City:
Zip: Phone:
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 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 rooms and accessory uses to an 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 )*opk or recording your Notice of Commencement„ ^ A
of
STATE OF FLORIDA
COUNTY OF
as Agent for Owner
The forgoing instrument was acknowledged before me
this 11- day of ��. _ : 20D by
i
l
(Name o rson acknowledging)
(Signature of Notary Public- S to of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
�r
of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instru ent was acknowledged before me
this _Z day of 20 t•7 by
(Name of person acknowledging)
- &a&4_1 WAU-.-
(Signature of Notary Public- St a of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
REVIEWS
FRONT
_1
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014