HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
D°1 3 �� Permit Number:
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-155.3 Fax: (772) 462-1578
PERMIT APPLICATION FOR: #
Address: _
Legal Description: ZaAe-cam=d Pc,.r k % 311K /16 1-6t Z2-
BY �� RECEIVED
ED
Building Permit App
Commercial
ition 13 ZOfB
Lucie C'oMht,�s P�r�-,
Residential
. P,t-,-re- f /_ --�
Property Tax ID #: %/3 Vl - 6 /1- 034 4 " 0001 Lot No. Z'Z
Site Plan Name: Block No. 1 / 4o
Project Name:
Setbacks Front Back: Right Side: Left Side:
oV�z-r
ditional work to be pertormeci under tnis permit - cnecK an tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
_ Generator
Sq. Ft. of First Floor:
_Windows/Doors
Roof Pitch
Utilities: —Sewer _Septic Building Height:
Name -.)4�%,:, 14r-m-iw,
Address:66-&C& a L6C�S fT/r�ti
City: P2Pce— State:
Zip Code: y�l� Fax:
Phone Noll Z= 33Z- 0655
E-M a i I : c-)•� R �-Cl ir. r�t� : .-,u—
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
Citv:
Zip Code:
Phone No
E-Mail
State or County License
Fax:
State:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER. _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 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
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before t e first inspection. If you intend to obtain financing, consult with lender or an attorney before
comnyring Wogk or recording your Notice of Commencement.
i .hut o�zjwWr jrkLessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFF ,
COUNTY OF
I
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledged before me
thlsVS day of 'F� 201 by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Nota Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification �
Type of Identification
Produced \, b ggAWAP„ARIEGNENS
Produced
PAY COPAMISSION # GG 022023
Commission No. *' `= EXpipglycem0er1s.2020
Undenvritars
Commission No. (Seal)
Bonded TW tdotzry Public
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014