HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO MUST BE COMPLe ttD FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: N10- 0 (00 (o
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
RECEIVED
Building Permit App licatiowc.11"'
SCANNED artment
p Coun
BY petsittin9 . i_ucie ty
St Lucie County
>1
Commercial Residential
Address: U Vista - ct> i
Legal Description: .3-5 b TOM 8 8. 05
��•. NE Cog. C),�= Nw , ply of-Nc °lti oy sw �.
Property Tax ID#: 0 3/2-- 0008 "'Q®0Z!?
Site Plan Name:
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
)'F+ S.
Lot No.
Block No.
Haaitionai orK to De perrormea unaer tnis permit- cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters �_ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator � Roof ��j z Pitch
Total Sq. Ft of Construction: o3.200' e Sq. Ft. of First Floor:
Cost of Construction: $ gbo. Utilities: —Sewer _Septic Building Height:
Name ,) V0 U 2(k�1 O
Address: $
City: T4� _ ?t E`CG? State:
Zip Code: 3Y q�j Fax:
Phone No.' C?S l/ / O o2
E-Mail: AA co wi n U lt/_? P -9milk., imm
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
City: State:
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.
DESIGNER/ENGINEER: _ Not Applica
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE 'TITLE. HOLDER: _'No't_AppIicable
Name:
Address: ,.
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder .
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged beforelme
this day of , 20_ by
this day of , 20_ by
Name of person making statement.
Name of person making statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification �.,
Type of Identification
Produced
Produced
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
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
Rev. 8/2/ 17