HomeMy WebLinkAboutBUILDING PERMIT APPLICATION"-ALL APPLICABLE INFO MUST BE L'UM'PLETED FOR APPLICATION TO BE ACCEPTED'
Date: to oZrj ~ 1:00 6CAMILU, Permit Number;
Build ft-Perlmoit'A pplicAtion
-planning and Development services SCANNN
Building and code Reruktion Djy&j0n 'BY-
116U - 0�9
23OO Virginia Avenue, Fort Pierce FL 34982- - St. Lude County
Phone: (772) 462-ISS3 Fax: (Tn-
) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end, offine
PROPQSED 6vtmN ;,'LOC TI
Address: SS
Legal Description::
i4unoo 612M 'Is
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mi 9 z.. Nnr
MSM
Property Tax ID #: -so I - 001 - 000 Lot No. -42-
Site Plan Name: ".OBlock No.
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F
ProjettAame: try
Setbacks Front
Back,; Right Side: IV Left Side:
a Fee
&AA%'A aQ 0A110 '439"-e'W V, -fii;j P..'
PooL feI-rcA. A#47� SLVld- 6A-& -r,, - CEO ktra?. 48 LL
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— uneman mar a
— WAC ZGas Tank 1P Gas P Shutters —Windows/Doors
— Electri! c Numbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost Of Construction: $ 5!ge)9L,10 Utilities: —Sewer _Septic Building Height:
Address: kjb� 0 J. OrAgAa
city: 7/saw State:-84
Zip Cooe:� 9 410 -- Fax
Phone No.-494 -4n) - 099LJ 'To,-,LjAwJTo
j&
RD In fee simple title Holder on next page ( If different
from the Owner listed above)
CONTRACTOR.
Name: I
Company:
City. I-ALK -COY state. R
rip Code:: 4 .. Fax:
Phone No. "PITI ?Q36
' )"-
E-Mail: A
y State or CountLicense:
ft-fte - -afi
value of construction Is $2500 or more, a REGARDED Notice of Commencement Is required.
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
AE 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 installatioh.ps indicated,
(.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 covenant;thatmay restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions4hicfumayapply,
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
r_ommencine work or recording vour Notice of Commencement.
o r
STATE OF MuRmA
STATE OF FLORI�.�„
COUNTY OF M i
�, �
COUNTY OF c ,
The forgoing instru ent w s acknowledg�efore me
• 20 by
day
The forgoinginstru e t as acknowledgefore me
this.L day of ZO by.
this of
(Name of pe oh acknowledging)
(Name of person a knowledging )
IL
(Signature of No a Sta
of Florida)
(Signature of Nry ublio- State off Florida )
ota
�Public-
Personally -Known N OR Produced Identification
Personally Known^ OR Produced Identification
Type of Identification Produced
entification Produced _.
*
Commission No.
BRITTANY R
tat of Florlde-Not
t Commission # GG
DDIN ,,.�`""' IT M7- D1
r �{�J � ` a �{ Fi••�i.�a Notary P.
on No. s, , tp9is�idn d Gr 90
1 ZI�Z' -
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`�,� My Commission
i �+Februar 26
My Can ow
xpires ''�� , r,9�' F9bretr.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW .
REVIEW
REVIEW
REVIEW
DATE -
RECEIVED
'
DATI�
COMPLETED
Rev. 7/ZL114