HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C
I
Date: \a�aA �d f
:`eOR APPLICATION TO BE ACCEPTED S
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR: 5
Address:
Legal Description:
Permit Number: Iq,a- Oy bG
RECEIVED
DEC 2 6 ZD18
Building Permit ApplicatiDA Lucie County, Permitting
SCANNED
BY
St. Lucie County
Commercial Residential_
PropertyTax ID #:
Site Plan Name: (-.7 ✓'o V
Project Name:
Setbacks Front ` s Back: . 5J . Right Side:_ Left Side:
.&Mechanical Gas Tank Gas Piping
Y-electric Plumbing rinklers
Lot No.
Block No.%
apply: r" i
_Shutters _KWindows/Doors
_ Generator %"-Roof // '7- Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ =30M Utilities: _ Sewer Septic Building Height: 2-1
OWNER/LESS E:
CONTRACTOR:
Name y � - -"t �'
Name: c/Sr.,
Address
City: - _ --_ State:_
Address:
City: _ a Y State:f�L
Zip Coder Fax:
Phone No. —
Zip Code: 4�� Fax:
Phone No 7 Z�
E-Mail:
Fill in f ample itle Holder on next page( if different
E-Mail �r�r% P si �DOa6 a i
State or C my Dense
from.the Owner listed above)
If valuelof construction is 2500 or more, a RECORDED Notice of Commencement is required.
%yam
FQ TI0 ;
Li P EM'
DESIGNER
Name:
rAL C • N
EN JrEER:
!}1L (� at),,,,
19nfflgnlLAW t
_ Not Applicable
,
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:
Zip:
Phone
tate: vl-- -
Address:
City:
Zip: Pone:
State:
FEE SIMPLE
Name:
TITLE HOLDER:
_tZ(Vot Applicable'
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City: l
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.
,rr ,
St. Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in,contlict 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 our property. A Notice of Commencement must be re r d and posted on the jobsite
before the firs s ction. If o intend to obtain financing, consult wi le er or an�tl�rnr before
commencin ork r reco In Qv lRotice of Commencement. / /// i
Owner
for Owner
STATE OF FLORIDA
COUNTY OF S �,
The forggoing instrument was acknowledged before me
this2Co day of iiac 20_ by
{g^nc\S � ♦��0� ram{
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced T- C-.D L
Pu
Commission
PIRE4: Dec°�yp�Undenfi�rs
,eFniNotyY
STAVE OF FLORIAA
COUNTYOF s . Lila
The forgoing instrument was acknowledge before me
this a day of t c 20_M by
I tg .,<\ $ 16\ ov,a e I 'S r-
Name of person making statement.
Personally Known OR Produced Identification
Type of Identification
Produced �_-L 0 L
(Signature
Commission
'.„�pJ, toop
REVIEWS
FR
INS
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/1/