HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONIAll APPLICABLE INFO MUST
Date:
i cD FOR APPLICATION TO BE ACCEPTED
I
Permit Number:
��sr,�UlJUC3l _ 81V
JU RBCFD'"�
�4 ���e���� :� � 01 201A
Pery7ittin9 De , a
Building Permit Application St' Lucieeoartment
my
Planning and Development Services
Building and Code Regulation Division
i
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: J r 4 el 74,60 / I- J h
II Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: s
®Setbacks Front
ftp s.
li17«1TrSiITI�/,�
i, ii ' A.
- _-
Left Side:
Lot No. I
Block No.
0
Additional work to be performed under this permit — check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters; ' .:.s �' 7lindows/Doors
L,-Ciectric `•'15'1'umbing _ Sprinklers _ Generator ✓ifoof Pitch
Total Sq. Ft of Construction: rd Sq. Ft. of First Floor,:p
Cost of Construction: $ *W 9y 0. 0 O i Utilities: —Sewer —Septic Building Height:
I _ I
OUVN`=R/LE=
IRAi:T19
Name �cty'er/y 46/ I
Name:ar r,%//,c
Address:
City: L State: ICl
Zip Code: �i L�9� Fax:
Phone No. �—
Company:
Address: '7 � / QS tdn4<<Z
�GJ1-14a
City: [ Stater
Zip Code: 3 L�Gi � Fax:
Phone No 2
�2
E-Mail �o
E-Mail:
Fill in fee sim a Title Holder on next page ( if idifferent
from the Owner listed above)
I
State or County•License . i1
II If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
i
DESIGNER/
GINEE :" Not!�Applicable
;MORTGAGE COMPANY: Not Applicable
Name:
/hl
A
_
Address
I
Address: _
City
State: y�i,
City:=' f "" " State:
Zip:
" "PFione _1d �7�—�1L/r%
—Try I
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_anyapplicable 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,concurrencyreyiew: room; additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessor`y'uses;to another.•nori-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�uvith lender or an; attorney' before
commencina work or' recording--vour Notice of'Commen cement.
Lessee/Co actor as Agent for Owner.
Signature of Contractor/License Holder
STATE OF FLO r •
STATE OF.FLORIDA; `
.
COUNTY OF
COUNTY`OF'
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this wT day of M&4 20_&- by
this day of , 20_ by
rn .
(Name of person acknowledging) I
(Name of person acknowledging)
(Signature of wry 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
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
�. Q
DATE
'COMPLETED°
Rev. 7/2014