HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE
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Date: os �
PLETED FOR APPLICATION TO BE ACCEPTED
"rCgP Permit Number. l �/
FD
MAY z
_ 21o�e SCANNED
- - Perm)&t,n
Bull &JL V& snit Application ������ ca���v
Planning and DevelopmentSe►vices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL �34982
Phone: (7.72) 462-15S3 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:. <OUV) IA) 121
Legal Description:
A-<� 4
Property Tax ID #: - 10
Site Plan Name:
Project Name:
Setbacks Front Bat
CJHVAC U Gas Tank
aElectric El Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ _
ff_I •Lot No.
Block
Right Side:
Left Side:
IIIL UncL,n an ;JJJJ9Y-
Piping _Shutters
nklers ❑ Generator
_ S . Ft. of First Floor.
utilities:0Sewer 0S.eptic
QWindows/Doors
D—Roof Roof pitch
Building Height:
'. ..0 - u f y ". �r .'�' `; 7 x P z'�;• t ji.e`� :
COrN TRACTO
.
Name
Name: Y
rii
Address:
Company: t
c
City E ,A �� -, State:
Address: 0)�
Zip Code: Fax: ��
City: �Q.
State. -_a
PhoneNofI12
Zip Code: AA AL Fax
-Q0i5
E-Mail:
Phone N U (6- tlLoQ
Fill in fee simple Title Holder on next page (if different
E-Mail:
.
from the Owner listed above) I
State or County License: 0,C
If value of construction is $2500 or more, a ;RECORDED Notice or commencement is requireu.
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RUCT� N�ttE�hi 1 1�i 0�31VIAT1(:�N `
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DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
State'
Address:
City:
Zip:. Phone
I
Address:
City: State:
Zip: Phone -
FEE SIMPLE TITLE HOLDER
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address-
Address:
City:
Zip: Phone- I
I
City:
Zip: Phone-
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to uo the wont ana msmnazion as inaicamd.
I certify that no work or installati n 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 o this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved Mans, 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: You 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 wunc Of t Cw
it jr, LPU1 �.�..�` ......
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wry►
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Signature of Owner/ t see/Contractor
as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLO r. A
COUNTY OFC` C
before me
20 by
The foreq' g instru nt was acknowledged
this v3 may of
The forgoing instrum nt was acknowledge before me '
this.3 day of 20r by
r "
Name of person making
statement
Name of person making statement
Personally Known_ OR Produced Identification
Personally Known _ OR
Produced Identification
Type of Identification
Type of Identification
'Produced
Produced
_
(Signature of Notary I
NAM. HILL
IM
(Signature of Notary Pub l' a
• "••:''. DONNAM. HILL
CO Nf N # GG 099038
Commission N
EX PfR
My&
Commission N = ION # GG 099038
Apn130.2021
.; ES: April3Q2021
11a,c-
,Pf:4 i Bonded That Notary PubUc Unden+ydteta
I
BondedThruNote=yp0cundemuem
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17