HomeMy WebLinkAboutBUILDING PERMIT APPLICATION_Electric _Plumbing _Sprinklers —Generator
Total Sq. Ft of,Constructioh: • Sq. Ft. of First Floor:
Cost of Construction: $ 40Uo Utilities: Sewer _ Septic
All APPLICABLE INFO MUST BE COMPLETED FORAPPLICATION TO BE ACCEPTED
Date: / 3 Permit Number: v 1
Planning and Development5ervices
Building and Code Regulation Division
2300 Virginia Aven ue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 3 ( 0
Legal Description: _
LIN
SCANNED
BY
St. LiiCflaC r!I f�•
Building re%rm€t application
Commercial�I Residential
Property Tax ID #: I q3�?_- 2 I QU U I - r7Q0 _ b Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas - Tank , as Piping Shutters ' Windows/Doors • r
r
Roof
Building Height:
W t ' =SSE T
COTRiTOR rt..�
- -
Name (�G^ /� 3
Name: r z�; S Ak",o �
Adss: %2,5 C y'/d+AY4
dre
Company: 'sI'lex2f- ,Z"5ra h
City: /-A/% 1,o) I State: /j
Zip Code: qI q &% 7 Fax:
Phone No. �71 ZA qP6 " 106 --1
E-Mail:
Address: 1i0) C Z 1 +ti ! 4
City: f-A /iYrcp Stater
Zip Code: 3 h 5 �J'7 Fax:
Phone NCO-7 Z� �/o I - 30 ? 3
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License Qb
If value of construction is Z500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable,
Name:
Address:
Address: '
City:
Zip: Phone
State:
City: State:
Zip:,i '"' Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicable
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
cornmencing work or recording our Notice of Commencement.
Signature of Owner/ Agent/ Lessee/Contractor
Signature of Contractor/License Holder
STATE OF FLORID I ` pp
COUNTY OF
STATE OF FLORIDA '
COUNTY
OF�c�Q
The fggoing instrum t sack owledg fore me
this day of� 20� y
The fprgoing instru en was a cnowledge jfore me
this May oy
�h�;
24
(Name of person ackno edging)
(Name of person acknowledge g )
I
(Signature of N ary Public- State of F(orida)
(Slgra of Notary Pu ic- State of Florida )
ovally Known . OR Produced Identification
P sonaliy Known OR Produced Identification
Type ication
Type of Identificatio
Produced
Produced
Commission No. (Seal)
"Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
.
Rev.