HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFJMUr 6"'OMPLETED FOR APPLICATION TO BE AL�tr TED
Q? _J C; Permit Number: 16
SGANIV&D 5�6-6
Lucie Co 0'( c::),
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Building
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 Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: el '�?Z'w Lot No.
Site Plan Name: Block No.
Project Name: 4!!�'/ Ree -1Z'z 52Lt C Aw
Setbacks Front Back: Right Side: Left Side:
Lp
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AdattionalworKtODepertormea under trus permit- cneCK all triat apply:
GasTank Gas Piping !.Shutters —Winclows/Doors
—Mechanical —
)� Electric — Plumbing Sprinklers G enerator Roof Pitch
Totai Sq. Ft of Construction: Sq. Ft. of Fi�st Floor:
Cost of Construction: $ Utilities: , —Sewer _Septic Building Height:
NOW,
Name _'Yc- k L-e' A v-rw
Name: �k 7-X-)
Address: Y-' ta
Company:
City: �-7� pke(-C- -e State: V4�1--Aciclress:
6�
City: State:-&
Zip Code: _. Gt2a Fax:
Phone No. LlGadz-41M
Zip Code: 3�� Fax:
E-Mail:
Phone No D 2 ? -7/1? 17
Fill in fee simple Title Holder on next page I if different
E-Mail J v"PNoi /�. J ez;�".2 e A&A e��
State or County License 0(,- 2,
1
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
LAPAPAM"
DESIGNERANGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
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 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
commencinLr work or recordiniur vour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Tignature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
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COUNTY OF n��__L J, klil
COUNTYOF
The oing instruTv�t wakylknowlecigpd-before me
The fapoing instruvrK t was aCKnowledg?pefore me
thislilf da, .20I,-)bvi . I
this I day of JK_ 201(:::)by
Cl %Ct )�*
w.,
(Name of perso acknowledging)
(Name of person nknowledg—ing)
ign urq 0 'ANN
Notary Public
Notary HUFF
Notary
:4 Uc
St 1
Perso a fication
Pe sona 0 Ofdbnjdfi tion
Type Comm. Expires May 27, 2019
234730
Type of lien 0 on edth ires 1 27.2019
Prod ticed"Ir.'-.41," Ronde ssn.
Produced V;�
v-��Assn�
Commission No. (Seal)
Commission No. ea
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Kev. 7/202.4