HomeMy WebLinkAboutBUILDING PERMIT APPLICATION•AII;APPUCABLE INFO MUST BE COMPLE `T !FOR APPLICATION TO BE ACCEPTED
Date:
X1-r ',IT d
Permit Number: � 5�l " a,s1
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
SCANNED
BY
Building Permit Application St. Lucie County
Commercial Residential
PERMIT APPLICATION FOR: Cez pip,^1
Address:
Legal Description:
C
Property Tax ID #: I ? 3 5 m ?()I— O I 000 + � Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
4c/� 1 11 i O'n v i v
1-r , i7AT
uuiundi wuin w uc Ncn ui a ICU unuo LIM pci Iun—IJICUK au a PC LdNNry.
_Mechanical _Gas Tank _.../GasPiping _Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction:$ 1510.06 Utilities: _Sewer _Septic
Block No.
Windows/Doors
Roof
Building Height:
g'�Y�fc'..c°'
Name:
Address:Name
• •Company:
Zip ..
Address:
i
..-Fax: ZipC:
•
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the •
. • .
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
�L
MORTGAGE COMPANY: Not Applicable
P
71
DESIGNER/ENGINEER: _ 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 bylaws
rules, 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, sighs, 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 Nolke of Commencement.
/
gnature of Owner/ Agent/ Lessee
Signature of Contractor/License Hol r
STATE OF FLORlDA
COUNTY 5 k. Lyc. N -i
STATE OF FLORIDA
�,
OF
COUNTY OF k. Lyc e
The forgoing instrument was acknowledged before me
this a \ day of 5q yN 20-AS by
The forgoing instrument was acknowledged before me
this a.\ day of "7 4* \ 20 \5 by
C�nt'�S�GO�,er S6Y\
0Y\
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Pu is -State of Florida)
(Signature of Notary Public -State of Florida )
Personally Known Ide?t4i'f�i lyd1 Florida
Personally Known OR Produced Identification
Type of Identification µcP . P4u1'o' c 16.79*
Type of Identification Produced t L
Commission No. L ram, • ' = My c°tg@' @�0�� # EE 6 ota�Y Assn.
Q NaoonalN
e E NA GIVE of Florlda6
Commission No. LJAS a ($'��c-Siatee 16 2p1
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:. P�oNotary ExPlcesD
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATI - •
`i
ANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
W
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014