HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETw iOR APPLICATION TO BE ACCEPTED
Date: 3` �3�1'� Permit Number:
BY
Bu°'ilding Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 'ell
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential Y�
PERMIT APPLICATION FOR: 1n'rgle
Address: 0i
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: 111 rC ut.► Rio b
Setbacks Front Back:
Aaartlonai worK to ne pertormea unaer
_Mechanical _ Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ q A O
Right Side: _
O, '�✓-� ,
DrK` C
Left Side:
rmit — cnecK ail inat apply:
Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic
Lot No.
Block No.
. Windows/Doors
ZRoof Pitch
Building Height:
Name o G
Name:vLyncc 1, %'a/' i 1,21 P d'
Address:
Company:
City:-} V e State:
Address:
Zip Code Fax:
City: State:
Phone No.
Zip Code: Fax:
E-Mail:
Phone No
Fill in fee simple Title Holder on next page (I if different
E-Mail
from the Owner listed above) I
State or County License
If value of construction is 2500 or more, a RECOfDED Notice of Commencement is required.
DESIGNER/ENGINEER: r/ Not Applicable MORTGAGE COMPANY: &P,'- Not Applicable
Name: ,Name:.
Address: Address:
City: State: City: State:
Zip: Phone Zip: ' Phone:
FEE SIMPLE TITLE HOLDER: 'Not Applicable
BONDING COMPANY: //Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:_Application.is hereby made -to' btain 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 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/Con ract r as ger?it for Owner
Signature of Contractor/License Holder
STATE OF FLORRDA
'�e
STATE OF FLORIDA
COUNTY OF Sit .- 1.V c
COUNTY OF
The forgoing instrument was acknowledgeA before me
The forgoing instrument was acknowledged before me
this jJ_day of Y`►w, S 20 by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Pu lic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known . OR Produc,�s)a ' ;
Personally Known OR Produced Identification .
Type of Identif ppAHR►EGNENS
Type of Identification
Produced Rc °"'P: .,Jd► SEA o14#GG022023
Produced
*' PIRE9: pecembef 16, 2020
P Ita ter✓
Commission N � , . '� ed ThN Notary denvn
Commission No. (Seal)
•, OF ,
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS'
eVEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REV54>
REVIEW.
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Re—v—.7/2014