HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONI� AII]�NPPLICABLE INFO MUST BE COMPLETEDPOR APPLICATION TO BE ACCEPTED
Date: �! �� I Permit Number:
/4A c3-��
Buill� i4p&am"Nit Application
MAR 2 0 9nm
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 GOmmercial Residential
Property Tax ID #: / �J v l/ Lot No. ?, l
Site Plan Name: I Block No. 7
Project Name: 1-
�i
Setbacks Front _i , ZBack:� �� Right Side r Left Side:
DETAILED DESCRIPTION OMOR,
a' v
e i C n i v ed_
/ A n )A /-io A 1 \ 11:,n r4 tom' e? YY-1-a A ,,7 /7 a,-, r •'
CONSTRUCTION°INFORMATION
Additional worK to be per orme under;thiS pe mit - Check all that apply:
_Mechanical _ Gas Tank Gas Piping _ Shutters Win PwS/boors
_ Electric _ Plumb! Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: i Sq. Ft. of First Floor:
i
Cost of Construction: $ /ff L t w Utilities: —Sewer _Septic Building Height: 1 0 �d gig,
' 1 I
OWNER/LESSEE
CONTRACTORS `''
Name v -/ ouch v
Name:
Address: / D 5, C. l- 4 e- i e
Company:
City: po(L* s4- L u G'i- is State: r-t
Address:
City: State:
Zip Code: 3 N 1 g 3 Fax:
Phone No. 7% 2 • Z -1 -2 3 30
Zip Code: Fax:
E-Mail:k m /HACK OLi i'I
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above) I
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEEMENTALCC}NSTRUCTIO`N LfIVLAW INFORMATIC}N•6
DESIGNER/ENGINEER:
9
_ Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
4&k f!
Name:
Addresses
Address:
City: 7
State:
City:
State:
Phone
Z
I
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 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
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
commen ing work or rqcording your Notice of Commencement.
Signature of Owner/ Lessee/Contractor awner
Signature of Contractor/License Holder
FLOR �
STATE. OF
STATE OF FLORIDA
M':;o••j
COUNTY OF yea *
,
COUNTY OF
The f r oing instrument was ac nowledg i�fggg�
thi/ day 2�y�ns s
The forgoing instrument was acknowledged before me
this day 20_ by
of
NNE
of
Name of person making statement.
Name of person making statement.
Person nown OR Produced IdePersonally
Lk
Known OR Produced Identification
Type of Iden ' ca ion
Type of Identification
Produced
Produced
(Signature of ry Public- State of orida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal.)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 812117