HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE C09i - TED FOR APPLICATION TO BE ACCEPTEL._s3*
Date: Permit, Number: 1QCS ' ()QS I
RECEIVED
Building Permit Application MAY 10 H19
Planning and Development Services SCANNED permitting Department
Building and Code Regulation Division �� st Lucie CountY-
2300 Virginia Avenue, Fort Pierce FL 34982 St. LOCI@ C �!
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial I ikiential
PERMIT APPLICATION FOR:
Address:
Property Tax ID #:
Lot No.
Site Plan Name: Block No.
Project Name:
Haa1110,pM1worK to De perro��rmm�ea unaerinis perm —cnecK aii mat apply: �
✓Mechanical "Gas Tank _Gas Piping _Shutters yWindows/Doors
vEiectHc Vplumbing �<Prinklers �nerator Roof Pitch
Total Sq. Ft of Construction: l a— Sq. Ft. of First Floor:
Cost of Construction: $ 06 , Utilities: _Sewer VSeptic Building Height:
IW Y 6. W
OWNER/
*x TOR:.t
�xN
Nam
-Name:
Address: t7. (
3
Company:
�I_
City: I
State: f)
Address `t
Zip Code: Fax:
City: State:_
Phone No. Z' (l0
Zip Code: Fax:
Phone No
E-Mail:
IQ;a�bon (' . t n rYl
Fill in fee simple Title Holder ongext
page (if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
.k Rv i A .h- ?: fi%S h A•'+ tt v*' 33^<.+PXT+S.0 +u^ ,..-c>P C •L �'aT',�" b A� A ,e
SUPPIEMENktC0A1SfRULI�tJIL(`LW'INfpRN1A7UN;'�
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
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
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
corD,mencing work or recording our Notice of Commencement.
MCM I��-
SI at re of Owner Le ee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA _
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument wa cknowledged before me
thissliCi day of 20� by
this _ day of 20_ by
W��"O�
-
(Name of person acknowledging)
•
4ign*atureof
(Name of person cknowledging )
Notary Public-S to of Florida)
(Signatu • of Notary Public -State of Florida )
'I N'J-,Qf-Jli
Personally Known OR Produced Identification
PersqAally Known OR Produced Identification
Type of Identification
Typ6 of Identification
Produced
P oduced
I
;•,�•' -•..:: NAINGRAM-RNiMING
Commission No.
++ •:+e My M�(i$�SIONNGG276060
=q•o�` F�(P1fecembef20,
Commission No. • (Seal)
2022
'•."'F...W Bonded Thm Notwy Public Underwdtem
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
,
RECEIVED
DATE
COMPLETED
Rev. //[U14