HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ar- 2.2\tea Permit Number:
SCANNEID
RECEIVED
Building Permit Application APR 06 201e
Planning and Development Services
Permitting gepaUtment
Building and Code Regulation Division 6g€I@ 0_ wly
2300 Virginia Avenue, Fort Pierce FL 349B2
Phone: (772) 462-1553 Fax: (772).462-1578 CO;mmercial Residential
PERMIT APPLICATION FOR:
Address
Legal Description: 'FSL(`!�'l�Gt1C_' �S Cam.�yc-e)k
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Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof i. Pitch
Total Sq. Ft of Construction: 1A Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
N a m e �,,tC_ Cf arm, \i,F
Address:2Q3c_5
City: Stater
Zip Code: �A- R\ Fax:
Phone No.` T-12-5-77'e30�
E-Mail: ��Sli�.i�)OCd,�rrrc,'l.Cam
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City:
Zip Code:
Phone No
E-Mail
State or County Licen
Fax:
State:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU�PLNiENTAL C�3NSTRUCTit3N i.IN tAW lNFQRJIA�QiV:�
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: - Not Applicable
Name:
Name:
Address:
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:
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 l-will, in"all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
i
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 toiRecord 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 our Notice of Commencement.
p i
Signature of Owner/ Lessee/Contractor as Agent
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF S k �1—��
COUNTY OF
Xn
The forgoing instrument was acknowledged bef
�om g
The forgoing instrument was acknowledged before me
this day of i , 20 by
"'�
this day of 20_ by
L� Y�
ORS
t�s T
J►
'I-J+ rl iv �O
C p�T
�' p3
(Name of person acknowledging)
a N
(Name of person acknowledging)
-
ad,., a tf��'
(Signature of N&Ary Public- State of Florida
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced .CD
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION -
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev.7/2-014