HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL A'.
Date
INFO MUST BE COI, TED FOR APPLICATION TO BE ACCEPTE -
�g Permit Number:
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- st. Cues Coup
Building Permit Application
Plann ig and Development Services
Buildi g and Code Regulation Division
2300 irginia Avenue, Fort Pierce FL 34982 l
Phon : (772) 462-1553 Fax: (772) 462-1578 Commercial Residential {/
PER IT APPLICATION FOR: To _
PROPOSED IMPROVEMENT LOCATION:
Addre �:.3339' /'�/v f1/� Aev�' /V-1� �z. 3�y99®
Legal escription: �1��//�/� SST /.O;P-
Prope I Tax ID #:/d r ��02 — D�D�O Lot No. .90
Site Pla Name: Block No.
Projec Name:
J J / /g��
cs Front /_ Back: 75- Right Side: /O Left Side:,—
DETA�LED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additi na wor to be nertormed under this ermit - c ec a app y:
1:1U VACE Gas Tank gas Piping Shutters Windows/Doors
0 E ectric 0 Plumbing Sprinklers OGenerator Roof
Total S . Ft of Construction: S Ft. of First Floor:
Cost of onstruction: $ %yORJ_" Utilities:T]Sewer Septic Building Height:
OWN
_R/LESSEE:
CONTRACTOR:
Name
Y G
Name:
: /P? Z�4./ a
Addres
City:
Zip Co
Phone
E-Mail
Fill in f
from t
Company:
State:
i
e:A049& Fax:
o.
Address: /a xr
City: a7A7 State:_/_1CZ
Zip Code: 3�19,471 Fax:
Phone No.
e simple Title Holder on next page ( if different+
Owner listed above)
l�%
E-Mail:
State or Count License:
If value f construction is $2500 or more, a RECORDED Notice of Commencement is required.
SU�PENINTkL
w
�C?NSTRUCTIC}N l:I.Et� L1/s lNFORMATlQI� ;
ER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
DESIG
Name
Name:
Addre
s: Address:
City:
State: City: State:
Zip:
Phone Zip: Phone:
FEE SI
� PLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name
Name:
s:
Addre
Address:
City:
City:
I' Phone:
I
Zip: Phone:
Zip:
OWNE / 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 ounty makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is i 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 accor nce with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follo ing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessorl'I structures, swimming pools,,fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNI G TO OWNER: Your'failure to Record a Notice of Commencement may result in your paying twice for
improv, ments to your property:, A Notice of Commencement must be recorded and posted on the jobsite
before he first inspection. If you intend to obtain financing, consult with lender or an attorney before
comm cin work or recording our Notice of Commencement.
J.,
Signat
f O er/ Lessee ontractor as Agent for Owner
Signatur of C tractor/Lt se Holder
STAT
OF FLORID
STATE OF FLORIDA�
COL
OF
COUNTY OF
The fo
this
oing instru nt was acknowledged before me
day of 20_�Fby
The forgoing instrum t was acknowledged before me
thisAL7 day of 20 Z? by
(Nametlif
person acknowledging)
(Name of person acknowledging)
Vat"
V
V
(Signature of otary Public-t e of Florida )
Personally Known - V OR Produced Identification
(Signature
Personally
o otary'Pub/lic- a of Florida)
Known ✓ OR Produced Identification
Type o
Identification
Type of Identification
Produc
ed
r uced
Comm
vx ey N qtary Public State of Flori
sion No. :° r� `(Se@�Icey L Rizza
8` My Commission GG 1687
Expires 12/1712021'
a F_d",'yta^0Pt
Co mission No. lary Public State of
2 acey L Rizza
My Commission GG 1
Exires 12/17/2021
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REVI,TWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA -TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEI
ED
DATE
COM
LETED
i
ev.
I
M
2�
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
PERMIT APPLICATION FOR:
�RC}OOS.Q INPR01lI1ENTCCATIt}N'' `$
Address:
Legal Description:.
I
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to bey pertormed., under this permit,- check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters ` _`Windows/Doors`
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: i„ ` Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height: I'
OWNERjLESSE
TRACTOR:
Name
Address:
Company:
City: State: _
Address: `
Zip Code: Fax:
City: ..'
State:
Phone No.
Zip Code:
Fax:
E-Mail:
Phone No
it
Fill in fee simple Title Holder on next page (if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.