HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLhTED FOR APPLICATION TO BE ACCEPTED`
Date: GGAN E® Permit Number:
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_ Buil ing Permit Application to
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Planning and Development Services ucie1)9 vn��nent
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 . Fax: (772).462-1578 C , rrimercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPR LO ATIO`N:
fO,,UE1MENT
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Site Plan Name: I Block No. —A
Project Name:
Setbacks Front Back: �'(�' Right Side: Left Side:
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Additional work to be pertormed un er t is permit - ch eck all tat apply:
_Mechanical _ Gas Tank _ Gas. Pipit g —Shutters _"Windows/Doors
Electric Plumbing _Sprinklers Generator Roof Pitch
o stFucl;' Sq. Ft. of First Floor:
c st off-om :tr�uctio.n: $ � r)nio Utilil ies: —Sewer _Septic Building Height:
OiA N �R L�-SSE
COi� RACTt3R:
Name Fae,i
Name:
Company:. `
Address:
Address: %
262
City: State: FL
City: State:
Zip Code: �C/s Fax:
Phone No. 77�Q-1.CP Cr "j
Zip Code: Fax:
E-Mail: /�- 20( �A�ahoiQ,Cd2D
Phone No
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
5 PP E T Gt T
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE -COMPANY: _ Not Applicable
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 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.
Signature of
STATE OF FLORIDA ,
COUNTYOF 'S)r, Lucy
ctor as Agent for Owner
The forgoing instrument was acknowledged before me
this36 day of iv%g,( , 20_11 by
(Name of person acknowledging)
(Signature of Notary
Personally Known _
Type of Ident'f! icatin
Produced
Commission No.
State of Florida )
OR Produced Identification
_ DEANNA MARIE GIVENS
MY COMBAISSION # GG 022023
0 ES: December 16, 2020
Unde jj� ru Notary Public Underwill
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
ype of Identification
roduced
ission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
a
DATE
COMPLETED
Rev. //ZU14 — N