HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLIETE._., )R APPLICATION TO BE ACCEPTED
Date: '`"�Permit Number: Dy
MAIN I loin,
' RECEIVEo
M-----Building-Permit-Application M^R o 1_zme
Planning and Development Services Permitting Department
Building and Code Regulation Division St. Lucie county
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: S"I X6
Legal Description:
0
m
PropertyTaxiD#: 3.11) -0003 Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank . _ Gas.Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: . ' 50100 Sq. Ft. of First Floor:_
Cost of Construction:$ 12—t7FCY0 Utilities: _Sewer _Septic
_ Windows/Doors
Roof G--'/-7Pitch
Building Height: �45
OWN ER/LESSEE:
CQ�JifiRLACfLQ ,,:
Name
Addre/�s:-�ign
i!)E1i A Mgi01-II - 64 -
Company:
City: �(f �• I i c i U. State: _
Zip Code: 34q F 7 Fax:
PhoneNo.- ��2-b-3�
E-Mail:
Addre s: 10 e
Ci Statet_ _
Zip Code: Fax:
Phone No 71cZ- 71' 67Fd,
Fill in fee simple Title Holder an next page (if different.
from the Owner listed above)
E-Mail
rf)
State or County License
N,
IT value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
PRL NIA TAI 14QCM
LIE LAW
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_Not Applicable '
BONDING COMPANY: _Not Applicable
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
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 tKat 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License, Holder
STATE OF FL I A
STATE OF FLO D nn
,//��
COUNTY OF o r, Ki t-aV
COUNTY OF Ihn ! i L)-P—R,
The forgoing in was acknowledgeA before me
The forgoing instru ent was acknowledggJi before me
%ent
this_dayo 201i1 by
this_dayof,201`_I by
(Name of person acknowledging)
(Na e f person acknowledging)
(Signa re of Notary State of Florida)
(Signat a of Notary Public- State of Florida )
�P/ublic-
'
Personally Known "1 OR
Personally Kn ea tion
Type of Identification a MNiGUERRE M F,STOCK
''
Type of Identi aSiitFyts MAfiGUFAREMESTOCX
i�
Produced'
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Produced &: .r. MY COMMISSIONMFF23S195
s+ EXPIRES: Octobers,
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�' BatledThrv_r!o ffiY PohE JM M ers
Commission No.P�h'"
Commission
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.7/2014