HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Permit Number: 11 Ia- dtl d�
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Building Permit Application DEC 15 2011
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: To Select from dropbox, click arrow at the end of line .
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Address: q5co
Legal Description
Property Tax ID #:
Site Plan Name:
Project Name: (�
Setbacks Front ack.
F]HVAC IJ Gas Tank ❑Gay
Electric 0 Plumbing ❑Spi
Total Sq. Ft of Construction:
Cost of Construction: $ comasou
Side: Left Side:
W/
ng LJ Shutters
ors ❑ Generator
S Ft. of First Floor: _
Utilities: LJSewer Septic
Lot No.
Block No.
QWindows/Doors
Roof Roof pitch
Building Height:
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Zip Code: R Ci �
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Zip Code: q1
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E-Mail: f�}
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Fill in fee simple Title Holder on next page ( if different
E-Mail.
State or CountyLicense:.
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from the Owner listed above)
I If value of construction is $2500 or more, a RECORDED Notice of
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5.UPPL MEN AL GON TRUCT N UEN 'WIN'FORMATION
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DESIGNER/ENGINEER: _ Not Applicablef
Name:
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City: State:
Zip: Phone
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY:
Name:
Not Applicable
Address:
City:
City:
Zip: Phone:
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 another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improve.Ments to your property. A Notice of Commencement must be recorded and posted on the jobsite
cc r i� first inspection. If you intend to obtain financing, consult with lender or an attorney before
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a in work or wordine vour Notice of Commencemen .
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signafurKof er/ Lessee/Contractor as Agent for Owner
SigWturdtof Con ctor/License Holder
STATE OF FL !ffW'k
STATE OF FLORA
COUNTY OF @A
COUNTY OF
The for ng instru nt was acknowledged before me
thisy of �L 20 by
The forgoing instru ent was acknowledged before me
thisay of Q 20LI by
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Name pers making statement
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Name o rso making statement
Personally Known � OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Not
(Signature of Notary
�""'••••., BEV L. HADDAD
BEV L. HADDAD
Commission No. = • ? MycoMMISI")GG009363
' ;�:i:P: •; # GG 009363
Commission No. = : .: MYCOM g�IQ
r. ;'%: •'o; EXPIRES: July 6, 2020
to, ThN Notary Public Underwriters
:,, EXPIRES: Jy 6; 2020
"�•'� o:•• goad Thiu Notary Public Undeiwrtteis
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
I 9
RECEIVED
DATE
COMPLETED
Rev.8/2/17