HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEP i ru
Date: Permit Number:
f�Dl�n(oc,1V
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: ' 59 �L ( G D
Legal Description:
SCANNED.
RECEIVED
St Lucie Count
Building Permit Application - 26 1018
Permitting Department
St. Lucie CountY
Commercial Residential (5)11-
0
P&Rcr lrG 3-
Property Tax ID #: �1 �% �� ��)li Lot No.
Site Plan Name: Block No.
Project Name:9Ceif/1') �% ` DeT`s'
Setbacks Front Back: Right Side: Left Side:
°o
Additional work to be performed, under this permit — check all that,apply;
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing Sprinklers ;i: _ Generator _ Roof Pitch
Total Sq. Ft of Construction: t 1 Sq.'' Ft.of'Eir—st Floor: .
Cost of Construction: $ o Q D Utilities: —Sewer _Septic Building Height:
Name A
Address:
City: e r,_7d- C P- StatAC14
Zip Code \/ 0 V G} Fax:
Phone No. 0 f — /
E-Mail: .1 11 U, (S
Fill in fee simple Title Holder on ext page different '
from the Owner listed above)
Name:
k` i? .
Company:
Address:
City: State:
Zip Code: Fax:
ne No
- ail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I
StJPP��MENTAL�OW, UCT11' L EN Al 1 I�IFaRMATIC
N:
.,.0... �.d .. 7.
DESIGNER/ENGINEER: _ Not A plicable
MORTGAGE COMPANY: Not Applicable
ame: I : ,;. _ .
_
Name:':
Address:
Address:
City: +`}i . State,,.
City: State:
Zip: .,..Phone
I
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable BONDING COMPANY: Not Applicable
_
Name: Name:
Address: Address:
City: 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 commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a,permit will authorize the ppermit holder to build the subject structure
is in
which 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, wall , signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Reco�d 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 tol obtain financing, consult with lender or an attorney before
comment' work or recording our Notice of Commencement.
W
S gna~ t' re"of!Own'er/ Lessee/Contractor s Age t r
Signature of Contractor/License Holder
STATE OF FLORIDA ��
STATE OF FLORIDA
COUNTY OF ��
COUNTY OF {
K.l
The forgoing inst nt was acknowledgg a rr��� z
this ° S day of 20/ Yb ��;
S :RL
The forgoing instrument was acknowledged before me
this day of 20_ by
m
(Name of person acknowl ,,,�+�:�dg•,,
Bing)
(Name of person acknowledging)
(Signature of NJAry Public- State of Florida)
(Signature of Notary Public- State of Florida )
!
Personally K n OR Produced Identification
Type of Identifica �f
Produced
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No. (Seal)
Commission No. (Seal) ..
I
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
S
PERVISOR
�EVIEW
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURTLE
REVIEW
MANGROVE
``REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014