HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONJul 05 2000 02:12AM HP FaxMirandb Sales 7728710863 page 2
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ALLAPPLICAPLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 Permit Number:
SCANNLL
BY
Building Permit Application St. Lu .n Carin
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 lol< Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
Address:
Site Plan Name:
Project Name:
Setbacks Front Back:
HVAC LJ Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction: ('� �7
Cost of Construction: $ 0 1 e Q 2—
Right Side: Left Side:
ter 1N6U-)
Lot No.1,
Block No.
� f -�
Piping UShutters ❑Windows/Doors
nklers Generator U Roof
S Ft. of First Floor:
Utilities:llSewer 0Septic
Building Height:
Namel
Name:
l
Address:
Cam,
L_AD
C
City, I' Stat :
Zip Code: Q Fax:
Phone No�Si�} c�
d s t
ty:
Zip Code
Phone No.-
UC1
State�-
Fax:
S
E-Mail:
Fill in fee simple Title Holder on next page ( If different
from the Owner listed above)
E-Mall: ' \ `J;GL..
iSiG(l -'C macoi
State or County License: '
It val ue of construction is 5Z50D or more,a RECORDED Notice of Commencement Is required.
Jul 05 2000 02:12AM HP FaxMirandb Salec 7728710863
page 3
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OESIGNE ENGINEER
Name:
'Address:
City:
Zip: Pha
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State: _
e:
City: State: _
Zip: Phone:
FEE SIMPLE TITLE HOL
Name:
Address:
City:
Zip: Phoi
ER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
!
Address:
City:
e:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application Is hereby made to obtain a permit to do the work and Instaiiation as indicated.
I certify that no work or inftallation has commenced prior to the Issuance of a permit.
St. Lucie County makes no �epreserttation that Is granting a ermit will authorize the permit holder to build the subject structure
which is in onflict with any appllcable Home Owners AssocPation rules, bylaws ppr and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your geed 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 appFoved plans, the Florida Building Codes and St, Lucie County Amendments.
The following building per tit applications are exempt from undergoing full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, sheen rooms and accessory uses to another non-residential use
WARNING TO OWNEfji: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to youri property. A Notice of Commencement must be recorded and posted on the jobsite
before�ie first inspection. If you intend to obtain financing, consult with lender or an attorney before
signature of Owner/Agen Lessee SgnatLire.DYntractor/License Holder
STATE OF FLO�{O STATE OF FLOI? ` t
COUNTY OF .7 1�LIt��__ COUNTYOF
The f a Ins nt was ackn wled ed before me�e�%1i.yo'�, The for I g Instrument was acknowl dged before me
this 0 a of '(�U 20-Eaby nyI''fy this Of 20�by s;
1 .n n C] F S. I (Name of person
flifgnature of Notary Public- State of Florida(Signature of Notary Public- State of Florida) g 99119
3 rtr In �
Personally Known OR Produced Identification Personally Known Produced Identification
Type of Identification Pro OR
Type of Identification Produced
Commission No. )E-7\ U'TG (Seal) I Commission N V?? (Seal)
Revised 07115/2014
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