HomeMy WebLinkAboutBUILDING PERMIT APPLICATION1301
All APPLICABLE INFO MUST BE COM1 --, rED FOR APPLICATION TO BE ACCEPTED l ¢
Date: II Permit Number:
Building Permit Application
Plannin and Development Services
Buildin�and Code Regulation, Division
2300 Vi�gmia Avenue, Fort Pierce FL 34982 ` v
Phoneii(772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: 1�a Qi_ INCd ` L t-}
Address
Legal DE
ption: L14 Ki-- c-�,yr C4,rzt�,/ 1' ^ fi—G
Propert�" Tax ID #:
Site Pla II Name.
Project Name:
Setbac�s Front Back:
1
Additi!1echanical
nal work to be pertormed under tnis permit— cnec
_ Gas Tank _ Gas Piping
lectric _ Plumbing Sprinklers
Total I . Ft of Construction:
Cost oll Construction: $ �— Utiliti(
NamIe `f 1.'E GIB A100071 V1W(Q&10l7 71
.'CState
Zip ode: Fax:
E-M@� il: Fill iih fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No._
Block No.
au tnat a
_ Shutters Windows/Doors
_ Generator v Roof e4 Pitch
Sq. Ft. of First Floor:
s: _sewer _Septic Building Height:
ifVame: �"/.`%�!•1'1.O.�iGr �,•C.�7�;!J;,�J�C�.
Company: :5r.00 /hie IV 0 /VG
Address
"City' /,� 4Q . _ Stater
Zip Code:. 3?eb 2l
` Fax:.
Phone No
E-Mail
State or County License �-� / 2 3
if valt'�e' of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAi. TRUCTION IkN !
FOR tON:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: 'Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
ii
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. I I;
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 nd posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with or an attorney before
commencing work or recording our Notice of Commencement.
Signatur o wne / Lessee/Contractor as Agent for Owner.
Signat a of ` ctor/Licens older
STATE O FLORIDA
ST E O. FLORIDA
COUNTY OF
C UNTY OFDi?�rvC,
The fgr oing instru gent was atknowledgecJ before me
v— (r�
The forgoing instru
w s ack(�owledge�¢;before me
cw i� /_(j
this' day of 20 byr
this d
20 by
A
rAl
43
(Name of perso ckn I ging)
(N c nowle ing )
(Signature of ota ic- State of Florida)
(Signature of Notary Pu
ic- State of Florida )
Personally Known OR Produced Identification
Personally Known
OR Pr duced Identification.
Type of Identification
Type of Identification
_
Lb
Produced
Produced
ZULEMA TONCETTICK
Commission No. 5': MY CO(8t)SION # G0005234
Commission No.
EXPIRES June 23, 2020
use
;p`�ZULEMA 70NCETTICH
407 o'
=': •": MY COMMISSION # 52
EXPIRES
June 23, 2020
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION (a
7 iRJ RTL5bri&
N VE
COUNTER
REVIEW'
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
1241b
DATE
COMPLETED
,
Rev.7/2014