HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2- « " ZO N Permit Number:
REMVED
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Bu11l0-. Permit Application PER
Planning and Development Services permitting Department
Building and Code Regulation Division St. Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential.
PERMIT APPLICATION FOR:
Address: IQ1� % S �: .• 12't,.1�f Qf Fad ��� fc�c� rL 3q Di F?—
Legal Description:
Property Tax ID #:'
-,--OOo 2 soov Lot No.
Site Plan Name: S�o� `` Block No.
Project Name: �% c �°-'"w
tn
Setbacks Front Back: 100 Right Side: Left Side:
pETAtLEQ pESCRIPT1QiU QF 1NORK� -° #
4 LP
CQNS1`RUCTIQN INI=QRMATION
Additional wor to be pertormed under this permit- check all that app y
:.Mechanical _ Gas Tank Gas Piping Shutters _ Windows/Doors
EIectrJc _ Plumbing 2930 C= Sp in e _ Generator' _ Roof Pitch
Total 'Sq. Ft of Construction:
Ft. of First Floor:
Cost of Construction: $ I'�, QC)®. C0 C-) Utilities: —Sewer _ Septic Building Height:
QWNER/LE$s.EE' w v
Name . ,_:.. _.. ... . ... _ ..
,4CQNTRACTQR.
K<_ -Pe-y\A L Name: r
Address: 10197-5T:--.1'..c.... Company: ;;5°i(— Chn.<t`005 f.CL
City: Ef Ac ti State: Address: SZ 90
Zip Code: 3g9V Z Fax: City: dd �'l 1���-z-- State:Kl-
Phone No. M -SS6 - 6 Z2 t{ Zip Code: 3 Yc 7 Fax:
E-Mail: Phone No 77 - 2.1`6 -13'-/1,
Fill in fee simple Title Holder on next page ( if different E-Mail OTC, P_c.e,
from the Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
I �
�0.TtC��
F.riT�`:`.'Address:
-Applicable
MORTGAGE COMPANY: ' Not
Name:
ddress:
City:
State: :City: State:
Zip:..Phone
Zip: Phone:
I
FEE -SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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 comm�nced prior to the issuance of a permit.
St. Lucie County makes no representation that '�s granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home 01�vners 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 request�d 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, tions,
accessorystructures swimmin g�ools, fences, yvalls, signs, screen rooms and accessory uses to another •no sidential use
WARNING TO OWNER: Your failure;to RI cord 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 firs ins ection. If you intenq to obtain•financing, consult with lender or an attorney before
commencin oyg'6decording your Notice of Commencement.
Sign of
of Owner/ Lessee/Contractor as Age
D�p$fl
Signat a oct ntraor/License der.�,,,,,-
ST FLORIDA
a
M�=
Ate_`
ST TE OF FLORIDA
COUNTY OF {
COUNL
TY OF
2 X. mK !0
The forgoing,instru nt was acknowledged
thiscieyof• - 20j
of r gre P3
b
The forgoing instru pen was acknowledged before a X g
this day of 20I� by a mc9
..
T
C �T79
Mg rr�
CAN
CAA
(Name of person acknowledging)
�
(Name of person acknowledging) m 8t.40
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4
�-.,A_ A-
............
1, ��
(Signature of Nota Pu - Sta a of Florida
(Signature of Nota reub ic- . tate of Florida )
Personally Known OR Produced Ide tification
Personal) Known OR Produced Identification
Type of Iden ifi ti n
Type of Ident 'cation
Produced �(�,
Produced ta
Commission N (Seal)
Commission o. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLAN /VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RE VI
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED`
ev. 1/2014