HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLET `ti FOR APPLICATION TO BE ACCEPTED
Date: ZI16117 Permit Number: �0&'
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 S%
PERMIT APPLICATION FOR:
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PROPJDb{R01%EiENTI.r,yUxN�.�;L! Frc,a,.: Fa�RA
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Address: /70/ 60Od,bWAR D Z2jQ - /,1E�C34495
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Legal Description: lq3 3 `70/--o5/ 9 boo/6
Property Tax ID #: Lot No.
Site Plan Name: , ,41?,4.015�6 1'01VJ< Block No.3
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona wor to a per orme un er t is permit — c ec a t at app y:
_Mechanical _,Gas Tank _ Gas Piping _ Shutters _ Windlows/Doors("
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: /$ Sq. Ft. of First Floor:
Cost of Construction: $ 2 D V DU Qtilities: —Sewer —Septic Building Height:
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Name KfnDAI 9
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Name: <�IY76
Address: /592 SW fORTWYC l217
Company:
City: !S 6 State: �L
S
Zip Code: 3 q 95 3 Fax:
: 3. 4.
Address:
City: State:
Phone No. 772— '7$-
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different.
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
1"
DESIGNE
Name:_
Address:
City:
Zip:
INEER:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: -
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name
Address:
State: City: State:
Zip: Phone:
I
Not Applicable BONDING COMPANY: Not Applicable
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 cor imenced prior to the issuance of a permit.
St. Lucie County makes no representation thlat 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 i lorida Building Codes and St. Lucie County Amendments.
The following building permit applications arle exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fencIs, 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 yourlNotice of Commencement.
I Lessee/Contractor as �gent for Owner - I Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF .r, o COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this I-Lo- day of , 20a by this day of 20_ by
I
(Name of person acknowl
WnafUre of Notary Public -';fate of Floi
Personally Known OR Produced
Type of Identification
t>i.,FlQ • 511D
Commission No.
,, Notary Public - Stat e(
- My Coissiones D
# FF
mm
Bonded lhrou9
(Name of person acknowledging )
(Signature of Notay Public- State of Florida )
Ily Known OR Produced Identification
Identification
Assn.
ion No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
•Z Z•��
DATE
'
COMPLETED
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