HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S. us ' 0 g Permit Number:
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: �7' 1 U
Legal Description:
Property Tax ID #:'`''�" X �;
Site Plan Name:
Project Name:
Setbacks Front Back
SCANNED
or RECEIVED
t �ulrip rmnty
Buil ing Permit Applicatio MAR 2 6 2018
S'r• Lucie County, Permitting
C mmercial Residential
Right
Left Side:
Lot No._
Block No.
Additional work to be performed under this permit — c 'eck all that apply:
r r ,
_Mechanical _ Gas Tank —Gas Pipi g .—Shutters. �V1/•iridows/Door
's -'
_ Electric _ Plumbing. _ Sprinkl rs _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $`0 Utili ies: _ Sewer _ Septic Building Height:
OWNCR E�SSE�:
CtJ TRAh • R:
NamemNe
Address: 15101 M),
City: State:�..Address
Zip Code: 34445 Fax:
Phone No.17 "` a) . b.
Company: p
State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail:
Fill in fee simple Title Holder on ne page ( if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of 'Commencement is required.
StJP'PL-MENT LOW N' STR{CTIfJJ R
EN tN
rC1FfUTAi N
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:...;.. ;.,
Address:
i
City: State:
City:, State:
Zip: Phone
Zip': Phone:
FEE SIMPLE TITLEHOLDER: _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
commencing work or recording your Notice of Commencement.
Signature of Owner/ Le ' see/Contra or as Agent for O ner
Signature of Contractor/License Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _Z(¢ day of CIA-RX-1 20-S by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging )
!�(
(Signature of Not!aPuffil4eettate of Florida)
(Signature of Notary Public- State of Florida )
Personally Known V1--**'OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
" r ced
/r�--pp :•a�';�• ORLANDOVAZQUE
Commission No. `�l� NA%4 1 ,z''� 'I Notarymissic-Stateo`
_' �) Commission=GG'39
5o%:da
=COm fission No. (Seal)
My Comm. Expires Fec 2tt
20:.,
'••Bonded through National Nat
ry As'.`
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW.
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014