HomeMy WebLinkAboutBUILDING PERMIT APPLICATION'All APPLICABLE INFO MUST BE COMP^ D FOR APPLICATION TO BE ACCEPTED
Date: Ci/ Permit Number.
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- BY
ter,. St. Lucas Co.lii +l�
I501-66��
Building Permit Application
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
PERMIT APPLICATION FOR:
u
Legal Description:
Residential
Property Tax ID �� " _0 ` u I &I J 0 d Q I Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
4Mechanical —Gas Tank —Gas Piping _Shutters
Y Electric _Plumbing _Sprinklers —Generator
Total Sq. Ft of Construction: co C/ Sq. Ft. of First Floor: _
Block No.
Windows/Doors
Roof
Cost of Construction: Utilities: Sewer Septic Building Height:
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Name V cw-'I d
Name: C �i e,K-[vrizG
Address: A (
Company: 1-:: fd saf d S {�ctfCphKG2 �l't G
City: rrf -- AcrcL'_ State: PC
Zip Code: Fax: /� �/�
Phone No.- ��� —6 (
Address: 10Ci0 SW/ B,1f*ktV7^Q Y+(01,1e,{
City: LDj, 1— S'} L-tIG 1 -f-- State:LC
Zip Code: 3 Ll Fax:
Phone No. i �C��Q `-7oL?61
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E-Mail: rddV £ i P� 0/0 C)491V(011 cya
Fill in fee simple T er on next page (i different
from the Owner listed above)
E-Mail: e DIy2C1Cr b1 i1a ty1 ` Q L261. C01
State or County License: C.(?C }a5�YQ S%
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Applicable
Address:
Address:
City:
Zip: Phone:
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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
commencing work or recording vour.Notice of Commencement.
Si� re of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORI
STATE OF FLORID
COUNTY OF
COUNTY OF O
The for oing inst ment as acknowledged b fore me
The foTing instr ent was acknowledged ore me
this � day of �� 20�y
this / day of by
(Name of person acknowledging)
ame of person acknowledging) 1
(Signature of Notary Public -State of FlMda )
(Signature of Notary Public- State of Florida)
Personally Known L�P,roduced IdentlftatttjRF ",
Personally Known OR'Producedddentificati
Type of Identification r.d olary Public, - State of FI 'da A
lie
Type of Identification Prods ' DAwN� r N€
Comm..Expires Mar 22, 2017'A-
; ? 'otary Public -State ON 'daCommission
No. `, �;- Com[5Wpp # EE 877571 p
Commission No. `e -�s� Co(R@ )pires Mar22, 2077
-'-•
Bonded Through National Notary Assn. ,
;oF.Lori Commission # EE 877571
Bonded Through National Notar -�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
/—/
DATE
osv'
COMPLETED
0g.
Rev. 772614