HomeMy WebLinkAboutBUILDING PERRMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �o n
Date: 5 Permit Number: b 0 3" 0�y
RGANNED
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
Legal Description:-Lv���C�r� �Vtf E4 S Ll A cls a" c S Lds .5J"ni e
Property Tax ID #: 34101 — 6d -Qo 5- — 000n. Lot No. �
Site Plan Name: Block No. S
Project Name: W
Setbacks Front Back: I Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas. Piping
Electric _ Plumbing —Sp
Total Sq. Ft of Construction: -!
1 Qh
Cost of Construction: $
rinklers
.,
Utilities:
Name je-nni ,.- I��i(k_L
Address: ':�,_�)--I __P1 I Mr Aj2 �r
City: E± i e ✓L C_ - Stater
Zip Code: Fax:
Phone No. 117 a - - 6 V J'
E-Mail: Ie y) n i L l.1_ Q_ bp_/ )cynu. d. , AHD
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Shutters _ Windows/.Doors.
s Generator
Sq:;Ft.-of First Floor:
—Sewer _ Septic
Roof Pitch
Building Height:
Name:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement -is required.
s •o
StRP�LEMENTA�L CQNSTRUCTIQN tiQRMA"tQN.g
$# g
>' .4.. .. a. e..b .�...
DESIGNER/ENGINEER: Not Applicable
;, MORTGAGE COMPANY:
_ Not Applicable
Nm ae:
Name: ...-......
Addres •
Address:
City:- ; State
City:
State:
Zip: IW-A a— Phone I - V 60- 46 ors
Zip: Phone:
FEE SIMPLE TITLEIHOLDER: _ Not Applicable
BONDING COMPANY:
_Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone: I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtairi,a permit to do the work and installation as indicated.
I certify that no work or installation has comm i need 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 Twill, in all respects, perform the work
in accordance with the approved plans,,the Flo Irida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory'structur'es; swimming pools, fences, iwalls, 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 Coriimencement 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 yecording your Notice of Commencement.
r
J"Q A
fiure of'Owrre / Lessee ontractor as Ag nt for Owner ,
Signature of Contractor/License Holder
STATE OF FLORI
STATE OF FLORIDA
COUNTY OF
�� °
COUNTY OF
The f r oing instrument was acknowledge fort
Q ^N v
SlL -�
a
The forgoing instrument was acknowledged before me
this day of a l' , 20 by
m z
this day of , 20_ by
WZ
er u�C 0-
(Name of person acknowledging)
m
(Name of person acknowledging)
P.
(Signature of NotA Public- State of Florid
')
(Signature of Notary Public- State of Florida )
/
J
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica 'on
Type of Identification
Produced
C,
Produced
Commission No., (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
EGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
�IZz(tg
COMPLETED
Rev. 7/2014