HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: O /. I L7 411
1
Building Permit App
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
RECEIVED
Permitting Department
St. Lucie County; FL
PERMIT APPLICATION FOR: r
�U� J JV 1A m � � Pip '.
P'ROP®SED INrPROVEMENMI
LOCATIC?N: 4�'HNI
vAdd(6ss ` Z ZG`-1 N 53'� St LurieG
J'
Legal Description:�,t-r-�a..tRL�
PropertyTaxITD�#Y Lot No. 2 i ZZ
Site Plan Name: Block No. _
Project Name:
Setbacks Front 32 • ti Back: / b 2' Right Sider Left Side:
work to be pertormed under this permit -
Mechanical _ Gas Tank -Gas Piping
_ Electric _ Plumbing _ Sprinklers
GTotaIr5q:'Ft of Cpjnstru'ction: 33fS
(Cost°of.,Construcfio'n:'$' \Sam
a
all that apply: L ,
_Shutters ✓Windows/Doors
6 1
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
OWNER/LE=�SSEE:
CONTRACwTOR:
Name:
reCA-
Company:
Address:
))ddress:
City: . `�; �c-ce. State: FL--
Zip Code: Fax:
City: State:
hone No. -7-72- c. 12 - '3ssZ8
Zip Code: Fax: '
�t Mailw?x�� r-.o,.. _ r�..s;c EJ �-4 F . nx�—
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement. is required.
SUPPLE ENTAL CCNSTI} Ci N IONN LA
INF4R
ATIQ
DESIGNER ENGINEER:
.,..._..� ,.�._....b._ _._.. _ __�....�
Not Applicable
I?p
MORTGAGE COMPANY:.
_ Not Applicable
�.._r
Name :, s ;,s c•, x,
Name:
Address wy 7
Address:
City:
State:
City:
State:
Zip: ,. §Phone
Zip: Phone.
FEE SIMPLE TITLE HOLDER:
Not Applicable
BONDING COMPANY:
Not Applicable
Name:
Address:V J ' ? ". } ; ; :-"
Address:
_ ...
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permitto 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.
STATE OF FLORII
COUNTY OF
Lessee/Contractor as Agent fo
FwnerAc—
The fo oing instrument was acknowledged beforeNMI,
this�dayofQ�i 0-1)- ,20aby P (Nam o on acknowledging) o
(Signature of 66tary Public- State of Floritfa )
Personally Known OR Produced Identification
Type of I i at'on
Produced W ✓�t
Commission No. (Seal)
Signature of Contractor/License Holder
.STATE OF FLORIDA
tOUNTY'OF
The forgoing instrument was acknowledged before mel;
this day of 20_ by
(Name of person acknowledging)
(Signature of Notary Public.- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA. TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW' '
REVIEW
REVIEW
DATE
RECEIVED
`I
DATE
COMPLETED
Rev. 7/2014