HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONl I -
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I Permit Number:
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M�@gPermit Application_Bun0e
Planning and Development Services F�8 ewty
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Building and Code Regulation Division I �WV140 oaV
2300 Virginia Avenue, Fort Pierce FL 34982 PQ st. `o
Phone: (772) 462-1553 Fax: (772) 462-1578 i Commercial . Residential
PERMIT APPLICATION FOR:,
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front . Back:
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Right Side: Left Side:
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_Mechanical _ Gas. Tank _iGas Piping
Electric _ Plumbing i Sprinklers
Total Sq. Ft of Construction: L-t�
Cost of Construction: $ I(1q O Utilitii
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Lot No. _3�X �37
Block No. _
_Shutters _ Windows/Doors
Generator _ Roof Pitch
Sq. Ft. of First Floor: '
s: —Sewer —Septic Building Height:
Name��ti�?...:Name:
0` /4moo-/oAn.5011
Address: � 'L�c�- a�
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YCompany: o�./•o�%n
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City: �114 AG"'_State: FL
,1 _ddre5s 29X S to
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Zip Code: Y�Y'9, Fax: I
City: ( v"OT 1*
- - Stater
Phone No. -77 2 — 3C7g — s�ys
Zip Code: 39-�KS 7
Fax:
E-Mail: Flamm tl 901& C
Phone No 4/1 7�
Fill in fee simple Title Holder on next page ( if, different
E-Mail
from the Owner listed above) :
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State or County License C
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If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: - ,Name:
Address: r ;Ad'dress:
City: ;. State: ''Cl 'ty,: State:
Zip.. -';Phone Phone:
�JrfR
FEE SIMPLE TITLt-'HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
_
Name: J;
'
Name:
Address: `'-+-..9�"Y
Address:
City:'
City:
Zip: Phone:
Zip: Phone:
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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
is in Home bylaws
which conflict with any applicable Owners Association rules, 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 the first inspection. If you intend to',obtain financing, consult with lender or an attorney before
commencing work or recording ur Notice of Commencement.
Si a of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID/ -
STATE OF FLORIDA
COUNTYOF ,
COUNTY OF
The forgoing instr ent was acknowledged before me
The forgoing instrument was acknowledged before me
this&.fL- day of 20a by
this day of 20_ by
(Name of person acknowledging)
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(Name of person acknowledging)
(' a re of Notary Public- State of Florida)
(Signature of Notary Public- _State of Florida )
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Personally Known OR Produced Identification
Personally Known OR -Produced Identification
Type of Identification �,�
Type of Identification
Produced ,Asj�r:,iNAIiIGRAM
of Florida
Produced
a�Pa+rue��, Notar: �� State
Commission No. =_�• :�, My Cc(Seal)�.4ires Dec 20, 2018
it FF 177249
Commission No. (Seal)
Commission
tional Nctary•
�'•%'� F�°PP� deE throtigA NaAm
y
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REVIEWS FRO ZONING SUPERVISOR
PLANS—))
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW
,
REV W
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
�( q
ev. 7/2014
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