HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONa
kill APPLICABLE INFO MUST BE COMPLE %�_ FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
SCANNED
BY R
' v G45� EcEzvED -
JUf
Building Permit Applicati n d � ,
(Planning and Development Services Sr. Lucie County, per
wilding and Code Regulation Division mitt;ng
300 Virginia Avenue, Fort Pierce FL 34982
it,hone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential_
11ERMIT APPLICATION FOR:
fI k tbiq,t.o��
Address: - -!� /D l-' /P®P,'
Description:
Prop rty Tax ID #: N'--\3 Lot No.
Site Pllllllan Name: 7,.j� L C; ►�( Block No.
Projeclt Name:
Setbalit Front QIA Back: ,�C Right Side:Left Side:
ditionlal l work to be pertormed under
_Mechanical Gas Tank
_ Elell ric _ Plumbing
Total Sq. Ft of Construction:
Cost of Con truction: $ P01
a�
permit - check a
Gas Piping
_ Sprinklers
apply:
_ Shutters
Generator
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
_ Windows/Doors
Roof Pitch
Building Height:
OWNI IR/LMR R E:
CONTRACTOR:
Name
Name: L��(','c Q� ��4R,ft f� m
Address: R6 '
Company: 4122 01ac,
Address:
City: p e.c..C_ State:
Zip Code: �� Fax:
City: fA 5r I , -cl p Stater
Phone No. 8, 61— �,7O'7- CM- d
Zip Code: _jq c6 q Fax:
Phone No -7-? bl _23 77
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail G 6,A 144(n %77Ca?R7Y-, �e
State or County License C' a C' 0kq Sy
from the Owl er listed above) ; °:
If value of cons#uction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ _ Not App
Name:
Address: _ ,� c,_S r� c�S r
City: LuC"IL'
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:_
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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 concu rre n cy. 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
commencing work or recording your Notice of Commencement.
Si ture of Owner/ Lessee/Contractor as Agent for Owner , _
Si a e of Contractor/License Holder
S ATE OF FLORIDA
STAT OF FLORIDA
COUNTY OF
COUNTY OF S
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledge before me
this 3'1 day of �� 20 by
this Zc_k day of 20_A% by
k ► ,ro.
'S A. vv\
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of NotarV 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 � IEGIVENS 1 `
DFNI G 02202
:� �%'•4, .; MMISSION # G 0 .�
M
Produced ,,.,,�, ANNAMAhrU-'dENS
:. i;:.. 19
'� •••••• ��= MY COMtdISStC N t� { I
Commission e si PJRES:)ecember;�S�aa)
CommissiorirNo. G�i� )December16,202 tg y
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o �hNeNo�ryPubTieUndetwti
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
tL
DATE
COMPLETED
Rev. 7/2014