HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr L
All APPLICABLE IN O MUST BE'COMPL._4D FOR APPLICATION TO BE ACCEPTED j jf
i - Permit Number: I -I l N
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Date: ANNE�
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-- BuildingPermit Application �p,�os1
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Planning and Developmerit Services t 4 96ep
Building and Code Regulation Division je clo4„h'e,,;,
2300 Virginia Avenue, Fort Pierce FL 34982 / Cy1�0;1.
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V /1�'1
PERMIT APPLICATION FOR:
Address: (�-FO S"� U-5fi 2
Legal Description:
ILI
Property Tax ID #:c� t.0.?f —��� �� Llt Cr'P% dot No.
Site Plan Name: d - UU(J - O - ,.. ck No.
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping —Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: t] ®Q Sq. Ft. of First Floor: _
Cost of Construction: $ (®� 0�% Utilities: _Sewer _Septic
Name -'(W A I' r A 04 i 1 94&0 Name:,
Address: r Compa'py:�
City: State: Address:
Zip Code: Fax: City:
Phone No. Zip Code:
E-Mail: Phone No _T1
Fill in fee simple Title Holder on next page ( if different E-Maillwp..4
from the Owner listed above) State or County Lip
_ Windows/Doors
L,-'Roof C�%ft SQ Pitch
Building Height:
Fax:
t
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicab
Name:
Address:
City: State: _
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicab
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 tolthe 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.
Slgnatur of Owner/ Leissee/ContrAebFAfs Agent for Owner
Signature Contractor/License Hol r
STATE OF FLORIDA / ,
STATE OF FLORIDA
COUNTY OF �L %�' �IyI
COUNTY OF ,��/I�i��r I�
The for mg instrum nt was a knowledged before me
The forgoing instrumen was ackn wledged before me
this Cday of 20� by
this LAday of 200 by
A Ot 0
(Name of person acknowledging)
(Name of person acknowledging)
(SiVature of Notary Public- State of Florida)
Si ure of Notary Puublic�St e of Flon a )
(Sill
Personal) Known OR Produced Identification
Y �
Personal) Known " OR Produced Identification
Y
Type of Identificati
me—
Type
Produced a �,. .,, JUSTINDAVIDCONE
-State of Fbrlda
Prod ��' JUSTINDAVIDCONE
y�Rat�i+c
�` commission# GG 196519
Commission No. '''�wM1 My Comm.Ex1a,2022 ,
04 commission 0 GG 196', 19
Com IS�t). My Comm. Expires Mar14,2011 (Seal)
on roughNaion otaryAurmL I
Bon roug a ion, o aryksn.
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:Fe—v. 7/203.4