HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE CO!Wvn fED FOR
Date:
TION TO BE ACCEPTED Q n J
Permit Number: 0 `✓SO`/
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 i
Phone: (772) 462-1553 Fax: (772) 462-1578 COm ercial Residential
PERMIT APPLICATION FOR: A-
M f t C + D C ► f�
PROP r SED INPK®W01 ENT Lt+?:CA1"IQ,N .
Address: z/ Ole -on V• r Or Pi-,erc4e�Z
Legal Description: 5" %! 1 Ae
Property Tax ID #: O OZ - 000 % I Lot No."PI
rSite Plan Name: Pa r iYr D C7a f c w .Block No.
Project Name: Pa4`r,-c,,o C�QYCi°�r
Setbacks Front Back: Right Side: Left Side:
DETAILS® DE�5CR1'PTIO;N ®F W®R+K:
Aaamonai worK to oe pertormea unaer.tnis permit— cnecK an tnat apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters _Windows/Doors
_ Electric _Plumbing _ Sprinklers _ Generator L Roof Pitch
Total Sq. Ft of Construc 'on::rrt C70 q. Ft. of First Floor. D 0
%`'•f—
Cost of Construction: > Utilitiesi —Sewer _Septic Building Height:
ME Is
CONTRAC7'®R
Name-�%i
I ame;
Address: Oleander, r' .
;Company:
City: r+ A-evce State:
Zip Code: S 14 R e 2 Fax:
Phone No.(,s (2r) Z 4 P—
Address:
City: State:
Zip Code: Fax:
PIhoneNo
EI-Mail
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Com(nencement is required.
DESIGNE /ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: �T (C i o C ° Name: '
Address: 2/ l eaAid f r 4v Address:
City: o f rc State: _ City: State:
Zip: ? y C - Phoneme; 6 0 2 yR- 0S03 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
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 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 toIanother 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 Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forg ing instru e t was acknowledged before me
thi day of 20& by
i Cif CO
(Name of person acknowledging)
nat of N ary Public- St/ate of Florida )
Personally Known OR Produced Identification `r
Type of Identification
Produced
AG IRMA MAYNARD
Commission No.&C ;�1(I�ig S@I@llry Public, State of Florid
Commission# GG 206912
My comm. expires Apr. 16, 202'
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
Type of Identification
Tm
uced
mission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE.
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014