HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONr
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 .
Phone 1 (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:' f�
Legal Description:
PropertylTax ID #: J %SDa
Site Plan Name: �1' ,
Project Name:
Setbacks Front_'- Back:
S ®Nb E®
ftucie County
Building Permit Application
Commercial _
Y_
Residential V
XX—
Right Side: -0 Left Side: �D
Lot No.1 il
Block No.
_Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. IFt of Construction: Sq. Ft. of First Floor: /A-
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Cost of Construction: $ �0� Utilities: —Sewer _ Septic Building Height:. t)
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OU1/N�ERLE�S�SEE:
CONTRACTC�7�R:
Name 'kV G kiY
Name:
Company,:
Address: 2 4
City: v" State:—L---
Address:
Zip Code: 7— Fax:
r ".57fiiT .
Cityr uJ•�� je.,,,.:i?irar,f State:
Phone No. �— `��
Zip Code: ax:
Phone No
E-Mail: i r—
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County cense
from -the Owner listed above)
If value of,construction. is 2500 or more, a RECORDED Notice of Commencement is required.
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,UfPPL �NTA 'QNS�' : � UN i�N LAW FORNfA 10
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: JZNot Applicable
Name: 12AV 114614 idyhName:
Address: ; e4v- l^ o
Address:
City: j State: t-
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City: State:
Zip: "' .Phone" % -
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 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
is in
which 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 inspect' you intend to obtain financing, consult with lender or an attorney before
commencing wor recor n •" our Notice of Commencement.
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Signat a of O er/ Lessee/Contractor as Agent for Owner
Signature' of Contractor/License Holder
ST OF FLORIDA
STATE OF FLORIDA
COUNTY OF S�ti`s,�"l_D ,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was knowledged before me
this "1 day of 0. 0 2011 by
this day of 20_ by
Q4afYv.c�nl� ('3111�.�1A
Name of pers making statement. Q
Name of person king statement.
Personally Known OR Produced Identification
Personally K wn OR Produced Identification
Type of Identification
Type of Ideritification
Produced
Produced
(Signature of Notary Public- Stat of Florida)
(Signature of Notary Public- State of Florida )
Commission No. ��eil HNA tNGRAM
Commission No. (Seal)
%
1RANNE
;_�Notary Public - state of Florida
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REVIEWS
FR i'% P, ��
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on # FF 177249
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUVIR
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REVIEW
REVIEW
REVIEW
DATE
RECEIVED
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DATE
COMPLETED
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