HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST
/BpE �
Date:
FOR APPLICATION TO BE ACCEPTED {�
Permit Number:
RECEIVED
Building Permit Appli
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
PERMIT APPLICATION FOR:
Address: 7 7 6f� 6:Y-e4e--",6 r/ ST,
c ition OCT Ill 2018
Permitting Department
St. Lucie County, FL
Residential
SCANNED
Legal Description: Sao
U
Property Tax ID #:.
Site Plan Name:
Project'Name:
Setbacks Front Back:
_Mechanical _ Gas Tank
}� Electric _ Plumbing _
Total Sq. Ft of Construction:
Cost of Construction: $
Right Side: LeftSide:
Gas Piping
Sprinklers
Lot No.
Block No.
Shutters _ Windows/Doors
Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Name lgwarPy r1ty-zer Name: �! /
Address: 7 ? 2 Yee v r1'-e ` 4�" ilc% Company: A a en/"c7wf-c ?y
City: T S T , "e Stater Addre ?
Zip Code: 3 !�!2 SSG Fax: City: �!7 Sr /u c..e Stater
Phone No. 7 %)- - 3Sr99- 6 /� Zip Code: � � Fax:
E-Mail: CZA5,r4NL4 Q 404 • Co/— Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail/2GT`l; C-, V Go,,
from the Owner listed above) State or County License 1-4-!2 1.301�t &A?
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
_Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable: I BONDING COMPANY: _Not Applicable
Name: Name:
Address:
City:
Zip:' Phone:
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 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
commencing work or recording vour Notice of Commencement.
.`Z)�...� Nam•
Signature of Owner/ Lessee/Contractor as Agenl
Signature o Contractor/License Ifolder :
l
STATE OF FLORID
a Xa
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nin
STATE OF FLORIDA
COUNTY OF
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COUNTY OF �
The forgoing'instrumeet was acknowledged befc
The for oing instrument was acknowledge bef 9 T
z3
this .� day of �,¢- . 20 by
this day of (�U}- , 2014• by Z m
(Name of person acknowledging)
(Name of person acknowledging) LJ
(Signature of Not Public- State of Florida )
(Signature of Nota Pu ic- State of Florida)
Personal) Known OR Produced Identification
Y
Personal) Known �� OR Produced Identification
Y
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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