HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4kAmk;D Permit Number: Lo
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Building Permit Application
Planning and Development Services ')eq� IM
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Building and Code Regulation Division SIL.
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address: C
Legal Descri
Property Tax ID #: I
Site Plan Name.
Project Name:cbfozb�
Setbacks Front Back: Ob
11
Right Side: 18 1 Left Side:'_1 '
Lot No.'
Block No.
EIHVAC 11 Gas Tank E]'Gas Piping S'hut'ters F]Windows/Doors
11 Electric F-1 Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: $ � � W Utilities'll SewerE]Septic Building Height:
I 9Q WA W 10 0/4 @ E—SO P E�l
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Name: I 1_�"
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Company:___��,& LEW Lk _Q.
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Address:15& 7SA&IJ
Zip Code* Fax:
City: State:
Phone No.
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Zip Code: FaZtlw-'-_� -':bg
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Fill in fee simple Title Holder on next page if different
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from the owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants that may restrict 6r 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
impro ements to your property. A Notice of Commencement must be recorded and posted on the jobsite
befo the first inspection. If you intend to obtain financing, nsult with lender or an attorney before
- ? oel'
0 ncing worWr
Mcording
your Notice OT Commence e
U
WnftTwner/ Lessee/contractor as Agent for Owner
§rg4tur of ont actor/License Holder
VILORIDA
STATE OF FLORI A
STATE
COUNTY OF Rul)lj
COUNTY F
The f ing in cknowledged
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before me
The oing instrKTent was; acknowledged before me
404
thiscS day
26A by
day of % I I
this — �A& 20IR by
NaWe of pe aking statement
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Na'nie of person making statement
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Personally Known_ OR
Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Nignature of Notary Public- S
jgrida
te,%-t BEV L. HADDAD
nature of Notary Public- State of Florida
Commission No�\ �('o
"f's MY omm ISSION#GG009363
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a- IVYPIRES:
BEV L. HADDAD
Co No.
July 6,2020
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1—br'u' Notary Public UnderwM
era E EYPIRES. July 6,202(
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REVIEWS
FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17