HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-
ALL AP LC BILE INFO MUST BECOMPLETED4§VOLICATIONTO BE ACCEPTED LIDS5_
Date: Permit Number:
.1p r
Building Permit Application
Planning and Development Services pe, St
Building and Code Regulation Division 'T?*A
. 49
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential 1`9�04t
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEI54ME*NTLQ ,QAT[
Address: 7 (A
Legal Description:
Property Tax ID #: 3362�4100-001
Site Plan Name:
Project Name:
Setbacks Front- 6C ► Back: /,LO
de: S- 1 Left Side: 60
Lot No. 17
Block No.
04P- C,0ffe1PC:,4P_ t9UXUD .,?& KW W1(.2_)
MW '�W' /T-al a puy� t cl 1110
Y A,
CONSTRUCTIONNF'OfW
Additional work to be Dertormed under this permit - check
all
apply:
1]HVAC Gas Tank DGas Piping
In
Shutters
Windows/Doors
Electric
Plumbing
Sprinklers
F 7V
14J
Generator
Roof
Roof pitch
Total Sq. Ft of Construction:
S Ft of First Floor:
Cost of . Construction:$ 1900,'90 Utilities:
Sewer 0
Septic
Building Height:
ETQ
ON
Name AMMA) Y A$J� L�
Address: E_A)a/WC_ C4&deA�� -
Name: OcizlniffKo
Company: a m ro er com -r90 L_ ray /4�e�
City: akE 'SrLa6�c S . tat;.T� �4_
Zip Code.M Fax:
Phone No.
Address: 1511
W B11-7-1XQt06S7_
City: PD47- r LUQ15 State:-R—
Zip Code:3ffq'Z - Fax: 7 9o? - flov, 5 26
Phone No. - 179S -
E-Mail: r1rnkL.CCS0eqfl)a1
State or County License: F-c- yvos/03
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
I
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City: I
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 Ownersl 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 exeImpt 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 Noticelof 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
rnmmonrina %nrnrk nr rarnrdina vnur Nntice of Commenrement_
I
gnature of ner/ Lessee/Contractor as Agent "for Owner
Signature Contractor/License Holder
STATE OF
OF ORIDqC� IItp
OUNTYOFORID�,,�
COUNTYOFSTATE
ng instru a as acknowledged before me
ThWay
thi of L 20 jg by
The forgoing instru �e t as acknowledged before me
this ay of L 2012 by
E4e,
aue, l�sLd/ fn"e`
Name of person making statement
Personally Known �_ OR Produced Identification
Name of person making statement
Personally Known _( OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of NotoyPublic- State of Florida)
(Signature of Nota ublic- State of Florida )
Commission No. 33 (Seal)
Commission No. 33 (Seal)
e a da
�.r°r Notary Public State of Florida
9
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17