HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST 6E COMPL ` --",)FOR APPLICA
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Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce PL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Com
PERMIT APPLICATION FOR:
Address:
Legal Description: Ica
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Property Tax ID #: I a(21 - UV l u
Site Plan Name:
Project Name:
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AMechanlcal _ Gas Tank _, Gas P
Electric Plumbing _ Sprin
Total Sq. Ft of Construction: QO ..
Cost of Construction: $ 1 -i CAD L
Name
Address: �1n
State:
Zip Code: QQol� Fax:
Phone No. �" (on "1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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rmit Application Iftfuel®
APR 19 2010
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Lot No. 1_
Block No.
_ Shutters _2L Windows/Doors
_ GeneratorRoof
Sq. -Ft. of First Floor: nA � ago
es: —Sewer —Septic 7�uildjng Height:
Name:
Company: _ i Si4
Address: L4h�
City;_. tyc�- State: �L
Zip Code: _eNCtG? Fax:
Phone No.
E-Mail:A& 1try P Ad214 & � il-�e/h�---
State or County License:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINIEER:
_ Not Applicable J i^MORTGAGE
.. MPANY:
Not Applicable
Name:
Name. G
Add res�q
Addres —=
City:
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t�e:
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City; !' � �� GJ'�.
Zip: Z15 Q. Phdne --. `T
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FEE SIMPLE TiTLE HOLDER:
_ Not Applicable I
BONDING COMPANY: _Not
Applicable
Name:
Name:
Address:
Address: I
City:
l
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 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 vour Notice of Commencement.
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STATE OF FLORI?�+,- STATE OF FLORIDA
COUNTY OF �c', COUNTY OF�)iLe,
The forggI g instr ent vias acknowledged before me The for Ding instrument yeas acknowledged before me
this -day of Ar( 20 by this day of , 20ff by
me of person acknowledging)
Notary Public -State of
Personally Known
Type of Identificai
Commission No.
Commission # FF 949733,
(Sapit(s January 12, 2020
Bonded Thru Troy Fain Insurance 800-M8,
REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
Gr � A
(Name of person acknowledging)
1
(si na ure of Notary Pu }ic- State of Florida )
Inally Known �>/_ _
of Identification Produ
on No. 15 . ° E ires January 12, 2020
P,,,,f B rey Fain Insurance 8003857019
SUPERVISOR I PLANS I VEGETATION I SEATURTLE I MANGROVE
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