HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO UST BE COMPLE'i ru FOR APPLICATION TO BE ACCEPTED
Date: a:3 SCANED Permit Number:
BY
I;$ i I Irip COWN
i
Building Permit Appli
Planning and Development Services j
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: v\A
Address:
Legal Description:
mmercial
0
ca ion MAR 2 3 �918
ST• Lucie County, Permitting
Residential
Property Tax ID _23yy _d0 \1�_ QA(3 " Lot No.
Site Plan Name: I Block No.
I
Project Name:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:/ I Sq. Ft. of First Floor:
Cost of Construction: $ (�� Utilities: _ Sewer _ Septic
/` �Windows/Doors
.� Roof !'Z Pitch
Building Height:
01NN ER/LESSEE:
CONTRACTf+7R;
NameTC,v-ie_a- r-A
Name:
Address: 4g91 [he 61 e,� cS'1 _
City: �-(jv-i- � ('�h'�D . StateFL .
Zip Code: 3 (4Q� Fax:
Phone No. Z- 22('0
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
E-Mail: aYYIfri7 1 6 Q_'VA J, ageqn
Fill in fee simple Title Holder on next 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.
U ' PL NI =NT L Cs@NSyTRt1CT14N LlINS1LA ION,FQR
ATlO
N DESIGNER EGINEER:
�
Name:
Address:
Not Applicable
— i Pp
MORTGAGE COMPANY: Applicable
Name-"
Address: �—
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
I
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 1permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florid la 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, wails, signs, screen rooms and accessoryzuses 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 Noticellof 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 recordinglyour N tice of Commencement.
&amI
I
1
Signature of Owner/ Lessee/Contractor as Agentl
for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Graf. 1-U C \e
COUNTY OF
The forgoing instrument was acknowledgA before
me
The forgoing instrument was acknowledged before me
this' .` day of �f' 4 20\ by
this day of 20_ by
' ye-Ger�►q
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of NotYy Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific - !
Produced DEANNAMARIEGiVENS
Type of Identification
Produced
4'F�le«9,°;,
* MY COMMISSION # GG 022023
PIRES: Dece
Commission No �;�� (891.2020
I
hnr Notary Public Underwriters
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014