HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONkil APPLICABLE INFO MUST BE COW , TED FOR APPLICATION TO BEACCEPTED
Date: 7-13— kt Permit Number: ��/� (J 7
SCANNED
Wit. Lu is �i'oun' j0
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential h�
PERMIT APPLICATION FOR:
PFtOROSED INPRC�3UEMENi` LOCAT)ON.
Alddress: 1%�%%vor« C , 3LI9 91
Legal Description:
I
Prooertv Tax lD #: 0 30— —j Lot No.
iite Plan Name: Block No.
'roject Name:
Setbacks Front Back: 30 Right Side: ad Left Side: '10
110xGo
Additional worK to be pertormed under tnis permit— cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 9,LV0 0 Sq. Ft. of First Floor:
Cost of Construction: $ 6000oa Utilities: Sewer Septic Building Height:
®UI/NEi2%I.E;S$EE:
CONTRACTQR:
Name
Name-,.
Address: `0 90 TJ o.r�<�<.. �c�.
r -
Company::
Address:
State:"�rL
Zip Code: 3 yaw-t Fax: to
City: State:
Phone No. 772-2y1- \\Gil
Zip Code: Fax:
E-Mail:Ila 11AZ'cc'-\
;Phone'No
E-IVlei.l
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 Commencement is required.
DESIGNE
Name:_
Address:
City: _
Zip:
NEER: _ Not Applicable
State:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
MORTGAGE COMPANY:
Name:
-Address:
City.
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
State:
Not Applicable
UW NtK/ GUN I KAG I UK AFFIUVIT: 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. I
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 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
commencingwork or recordingour Notice of Commencement. - .
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ��� riG,.
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this /3 day of .2/1 v , 20-Zrby
this day of 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
��
Personally Known OR•Produced Identification
Type of Identificati .
Type of Identification
Produced
Produced
A/
p��m
(Signature of Notary Public- Sta f Florida)
M X o(Signature
of Notary Public- State of FloridaU,
Commission No. (Seal)z�
Vt.>
20Commission
No. (Seal)
c. o
REVIEWS
FRONT
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER.
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
(�
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DATE
COMPLETED
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