HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Acftza
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Mau iig'Application �90 zone
uanning and Development Servicesuilding and Code Regulation Division t �uc�e County ent
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2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ft
PERMIT APPLICATION FOR:
Address:
Legal Description:
Ln
Property Tax ID #:
Site Plan Name:
Project Name: 07.40
Setbacks Front Back: _
EJ
rn& t k v I
I
Right Side:
Additional work to be pertormeo under tnis permit — c ec
_Mechanical _ Gas Tank _ Gas Pip ng
Electric _ Plumbing _ Sprinklprs
Total Sq. Ft of Construction: 0
Cost of Construction: $
Uti
Name 1W fJ0 rc2oC& Lse CA_ ^e_r
Address: Z(40(,o (gatx, Af--
City:qzD V"3r' ?; State_(-
Zip Code:-114 Q 411 Fax:
Phone No.%",� '7 rr�, Sri Q ' 1$ 1(4
E-Mail: %G k_AA .(it
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
all tnat apply:
Shutters
_ Generator
Sq. Ft. of First Floor:
s: —Sewer _ Septic
Lot No._
Block No.
U
_ Windows/Doors
_ 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.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: 4 2 i- At S GS Name:
Address:,- l ' Address:
City: State: [. City: State:
Zip: Phone—Z f,. cy a - 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 buildthe subject -structure
which is in conflict with any applicablIe }tome Owners Association rules; bylaws.or and.covenants that may restrict or prohibit such
structure. Please consult with your Kome 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 concurrencyreview: room additions,
accessory structures, swimming pools, fences; walls, signs, screen rooms and accessory uses tdi a' hotlier 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, corisult'with le'nd`er or an attorney before
commencm work or recording your Notice of Commencement.
't 0, /
-
Swiga emf Owner./ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE_ OF FLORIDA
COUNTY OF `;f' ` L �i .- - -
_tOUNTY'OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of r ioft%\ , 20,jf by
this day of 20_ by
'_SQC J 0'() 1GGff1P "r
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification ✓_
Personally Known OR Produced Identification
Type of Identifi tion
Type of Identification
Produced
Produced
ignatuj§.cff Notary Publi ate of Florida)
Joshua J
(Signature of Notary Public- State of Florida )
cooc GarciaCommission
No.S Z 2 (S°NOTARY
��i%ission No: (Seal;)
t,g1gR1
STATE O
FLORIDA
Comm# G
3157292
e Expires
11/1/2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE: ;
!MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
=REVIEW..,. ,'
REVIEW.,._
REVIEW
DATE
RECEIVED
�_
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_.,' > • r ..-
~"'
DATE
COMPLETED
Rev. 81ZI17