HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMP FOR APPLICATION TO BE ACCEPTED
Date: % -/ 0 poc-- Permit Number:
9CAN OD
BY
Bu'i 19giRP&gr it 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
PERMIT APPLICATION FOR:
Legal Description:
L&A"TION,
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95_operty'Tax-, I' D#: f �r� /— �/ Z — 6 2 9 � /� /�� - / � Lot No. 1 D
Site Plan Name: Block No.�
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF'WORK �. r
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Residential
Leo k borof ",Or, Lle� Is �4 // '02 "�'J 66, 4 /--5 7,4 4!� &Ae. t"Pe",
14SA // , 5' (1—rt,,,�7 ?4,/ 1//o"rT flnA o ',S4cs/ noc-L3 2)6,i Pe We
CONSTRUCTION INFORMATION
Additionalwork to a pertormed under this permit — c e& a11 that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator &AM 1F off' s' P fch
%T tal°S`��-Ft''of�Co st uction: r q � �2 242!�' Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
CrUVNER/.ESSf E . =, ; `�o
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CONTR�4C1'.OR;'. _ o
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Name:
Company:
Address: v nn 12a
City: i CrCQ
State: �,
Address:
Zip Code: I g �� Fax:
City: State:
Phone No. Z 32 - 5`0
Zip Code: Fax:
E-Mail: ` Ot I'Q.
C°
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:' _ Not lApplicable MORTGAGE'COMPANY: _ Not Applicable
Name: Name: -
Address: I Address:
City: State: ;City: State:
Zip: Phone Zip: - Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not pplicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: I Address:
City: I City:
Zip: Phone: I Zip: Phone:
I
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 commenllced 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 such
prohibit
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
(permit,
In consideration of the granting of this requested 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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent or Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- State of Florida) I
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUFitMSOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.