HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLI
Date: Ol
LE INFO MUST br_ 60MPLETED FOR APPLICATION TO BE ACCrri'ED
Permit Number: M I Z50r)
Building Permit Application APr tioG �`�jGFo
Planning and Development Services
Building and Code Regulation Division ��c;P aPp j0�9
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address) ft61 IC4W,4Fr
Legal Description:
• J7,L a-fI ft -
Property Tax ID #: Z7 705 00+1 XQ - Lot No._
Site Plan Name: Block No.
Project Name -
Setback
s Front `� Back16� Right Side: �� Left Sider
pAiro , w o H ),Diu( fwop_
County
Haaitionai work to op errormea under this permit - check all apply:
�HVAC Gas Tank Gas Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers E]Generator E]Roof Roof pitcli ."
Total Sq! Ft of Construction: '!� S . Ft. of First Floor:
Cost of Construction: $ 1Z, 000 Utilities: Sewer Septic Building Height:
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Name
MINI
Name: W—rai :1 &11 Ld �y / r OL-
Addressi
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Company:
i State:
u,�4 '
Address: 00% A119KI 0,0Y0109 j94-
City: .•T��
Zip Code:
_
/ Fax:
City: �-i m" Stater
Phone No.
E-Mail:
Zip Code: Fax:
Phone No. 56 - - S 0
Fill in fee
from the
simple Title Holder on next page if different
Owner listed above)
E-Mail: `(VT(�
State or County License: / IG, _3 f 6
IT vaiue oC construction is bZ5ao or more, a RECORDED Notice of Commencement is•required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name
Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Applicable
_
Name
_Not
Name:
Address:
Address:
City: I
City:
Zip: Phone:
Zip: Phone:
I
OWNEF/ 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'I 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 ing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
_structures,
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 recor�ding your Notice of Commencement.
- S��
wroi
Signature
-
of Owner/ Lessee Contractor as Agent for Owner
Signature of ontracto /License Holder
STATE
OF FLORIDA
STATE OF FLORIDA
COUNTY
OF 3;
COUNTY OF ST LGiG�E
The forgoing
instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 151
day of _ 1V6y'6inf U , 20 A9 by
this L day of 11/dye heA 20 .19 by
Personally
Name of person making statement
✓
Name of person making statement
Known OR Produced Identification
Personally Known OR Produced Identification
Type of
Identification
Type of Identification
Produced
FLbL
Produced FL7�L
I
(Signatur
o Notary
(Signature of N y Pu
-�
BINNS SR.
n„�., �!
`"""�� ORI J BINNS SR.
°<'; State o�b�I a -Notary Public
Commi
sion No. C�'
,t`"ri'%.
`� `Ai
i 4,;State of o-n-�(a-Notary Public
_ / *_ Commi il# GG 263150
Commission No. 66 Z
My Commission Expires
September 27, 2022
�' Commission # GG 263150
.. My Commission Expires
September 27, 2022
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
plow
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
RfVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
1116100
DATE
COMP
ETED
Rev.8/2/
7