HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / a • ?:9. 1% Permit Number:
Planning and Development Services
Building and, Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
SCANNED
BY
St Lucie County
Building Permit Application
Commercial
PERMIT APPLICATION FOR: 9CN U a4t - / UN
Address:
Legal Description:
A L/ ►fitnes 5lZ) =?has� 1t1-cam
PropertyTaxlD#:
Site Plan Name: ff
Project Name: N12111-019r T t rle's
Setbacks Front Back: Right Side: Left Side:
WC 2 9 2ou
Residential
Lot No.
Block No.
_iiviecnanicai _ t3as i anK _ k3as raping _ 3nutters _ vvinaUws/ vuurs
X1EIectric A lumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 6'q Sq. Ft. of First Floor:. .
.P
Cost of Construction: $ , 5�/� Utilities: Sewer —Septic Building Height:
Name
Address: i&ee20n -b e—
City: >D PlPorrP State:,.
Zip Code: ��L%c5�� Fax:
Phone No. M
E-Mail: fm : Yl I MDM ML/ 1 GDCLMC(t1 (1cb.
Fill in fee simple Title Holder on next page (If different
from the Owner listed above)
Name:
Company:
Address:
City: State:
Zip Code: Fax:
rPhone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/%ENGINEER:
_Not
pplicable
MORTGAGE COMPANY: Not Applicable
Name: C �^
Name:
Address: ,S
Address:
City: .J Z Ai &rc -e
State:
City: State:
Zip: ,Oaf Phone's 17
%Z -- a,
r,6-_ -5/,,-L�
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not /applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:,
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT; Applica pion is hereby made'to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commen ed prior to the issuance of a permit.
St. Lucie County makes no representation that is E ranting 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 3errhit, I do hereby agree that I will, in all respects, perform'the work
in accordance with the approved plans, the Florid -,Building Codes and St. Lucie County Amendments.
The following building permit applications are exe pt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wa Is, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Rec rd 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 t obtain financing, consult with lender or�ah attorney before
commencing work or recording -your Notice of Commencement.
T'
tractor as Agent for Owner
STATE OF FLORIDA-A
COUNTY OF '
The forgoing instrument was acknowledged bef re me
this ,,2A day of Z e c , 20-4 by
0TtIW3. MVME%17
Name of person
Personally Known OR Produced Identifica
Type of Identificat' n
Produced
»e
re of N�fary Public- State ofTlorida
Commission No. (Seal)
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal.)
REVIEWS
FRONT
ZONING
UPERVISOR PLANS
VEGETATION
SEA TURTLE
'MANGROVE
COUNTER
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 81211.1