HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPL�C�ABLE INFO MUST BE COMPLETED F' "' APPLICATION TO BE ACCEPTED
Date: Permit Number: ( 9 M0 Q0
SCANNED ruFD
BY
1 ; AUG 1.0
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BuiY ing Permit Application Permitting pe
il Lucie ment
Planning and Development Services county
Buildin and Code Regulation Division
23001 rginio Avenue, Fort Pierce FL 34982 /
Phone (772) 462-1553 Fax: (772) 462-1578 Commercial Residentialy
PER
IT APPLICATION FOR:
Address
Q
Legal D
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�cription:
Propert
Site Pla
Tax ID #: T� � '` 60'112 4 Lot No. i t � L •�
Name: Block No.1��
Project
� Name: .OD+
—W-AL
Setbac
Front Back: Right Side: Left Side:
i
Gr-
1)j)J1' ividud :0( 4 "-d 4� A
NQRM,* ,
.. .. .__.. ._ .... .:. ..:
itio
al work to be pertormed under this permit — check all that apply:
_Mechanical
_ E
_ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
ectric _ Plumbing _ Sprinklers _ Generator 1z Roof Pitch
Total Sc.
Cost of
Ft ofConstr ction: r !C Sq. Ft. of First Floor: �� V
1 S�F� Se g g
i onstruct?,Sewer on: $ !� Utilities: _ ptic Building Hei ht: _
":
Name:
Name'
�s:
Company:
Addre
i l eIruo_ State: P
Address:
City:
City: State:
Zip C
1de$ Fax:
Phon
E-Mail
Fill in
�
No. — Z —16 '
Zip Code: Fax:
Phone No
i
fee simple Title H Ider on next page ( if different _
E-Mail
State or County License
from
he Owner listed above)
If value
If construction is 2500 or more, a RECORDED Notice of Commencement is required.
ill
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name: j
Address: ''`''' Address: Ill
City: State: City: State:k
Zip: Phone Zip., Phone:
III
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 permit holder to build thesubject structure
which is in conflict'with'ahy: applicable:.Home Owriers.Association rules, bylaws-or-andcovenan'ts'that may restr'ict:.or.prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In cori'siderati'on of the grariting of this -requested permit, I. do hereby agree•that�l Willjn all respects; perform,,the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments. 11 _
''
The following building permit applications are exempt from undergoing. a full concurrency.review: Foom additions, I
accessory'structures, swimming pools, fences, walls, signs, screen rooms and acr_essory uses toIanother' non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice fd;
improvements to your property. A Notice of Commencement must be recorded and posted o,n;the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attornejbefore
commencing work or recording our Notice of Commencement. !,
it
1.
ure of owner/ Lessee/Contractor:as gent for Owner,
Signature•iof. Contractor/License Holder II
- ,v
STATE OF FLORIDA
STATE OF FLORIDA ! t
COUNTY OF SA
COUNTY OF
The forgoing instr ent was acknowledged before me
The forgoing instrument was acknowledged before me
this M day of 2011_ by
this day of 120 by
r
Name of person making statement—
Name of person making statement.
Personally Known OR Produced Identifications
Personally Known OR Produced Identification Ili
Type ofjLleQtif' ation,
Type of Identification
Producetim
Produced:-•;.,
at re of Notary Public- State 6f Florida)
(Signature of Notary Public- State of Florida )
Commission No. .a�`�'r"n,, LA�I�� INGRAM
Notary'Public - state of Florida
Commission No,' Seal
,
:tow . #•�.,
; • _ My Comm. Expires Dec 20, 2018
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REVIEWS
.I!
OF V.••�
�r"„"�
commission
9
PLANS
VEGETATION
S LE :
-MANGROVE
CF
Ewi,t
REVIEW
REVIEW
REV EV1/EA
REVIEW
DATE
RECEIVED
DATE
COMPLETED 8,13t
Rev. 8/2/17