HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICAB E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: %D 2(,� ina Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virg I"nia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 . Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 1 wz.
Legal Description:
Property Tax ID #: Q
Site Plan Name:
Project Nalme: _
RECEIVED
Building Permit Application. OCT 2 6 Z018
ST. Lucle County, Permitting
Commercial Residential 7
Way FM�E
Setbacks I Front Back: Right Side: Left Side:
Lot No.
Block No.
Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construct o/ Sq. Ft. of First Floor:
Cost of Co I struction: $ v �� Utilities: —Sewer _Septic , Building.Height:
I
Name �11 I We-te-1 AA..'
Address: i zq S 4 ✓-,zca- -Plz-
City: %p2T Ff (5&c6 State: f
Zip Code�: `mel Fax:
Phone No. '772- 2y1-yq9/
E-Mail: 6 ►'-1.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) -
Name:
Company:';...
Address:
City:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Sl1 PLE i ANTI.Mil
U
N
R, r Il..
DESIGNER/ENGINEER:
Name:. Bo...
Address: o 4
City: 'rwof Fd4ze _
_ Not Applicable
I-&4t 1 h6yle fig mee,,j!�t
A� ��
State: 4a—
MORTGAGE COMPANY: _ Not Applicable
Name: C';ka-,e., 11�� F1,1 Ce
Address:
City: State:
Zip: Phone . :17z-
2o —1395
Zip: Phone:
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-ipstallation 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�con`sultIw tfi 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.
Signpufe of OwneV Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY -OF r
The for oing instr ent was acknowled before me
this day of 2q by
Name of person making statem
Personally Known OR Produced Identification ✓
Type of identWcatio
Produced i-L
(Signature of Notary Public- State of Florida )
Commissio KAREN S. NIELP@Nl
ar° State of Florida -Notary Public
' Commission # GG 207484
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20_ by
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Notary Public- State of Florida )
Commission No.
(Seal)
My Commission
June
txptres,
12 20
REVIEW
PERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 812117