HomeMy WebLinkAboutBUILDING PERMIT APPLICATION411 APPLICAB E INFO MIJIST BF COMPLETED FO'
Date:
'PLICATION'TO BE ACCEPTED P, '? ��
Permit Number:
S E�LUCI
C a-D it
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
SCANNED
Building Permit ApplicatiO "pie count
y
Commercial Residential
%wA)oh/e"aL CianS-cJ9VC'
Property Tax ID #: t�Yd5-�V-,3lop- ®0D y
Site Plan Name:
Project Name:
Setbacks Front Back:
Mechanical
Electric
_Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 28 9
Right Side: Left Side:
e- 4 ^ ChA✓ISC 0
3S
PCI II IIL-u IV; .- rr p.
_Gas Piping _Shutters
_Sprinklers _Generator
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
City': State:°>
Zip Code: 1B011 Fax: 7�7d
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is2Sarlor more, a RECORDED Notice of
City:
Lot No.
Block No.
w/
_ Windows/Doors
Roof
Building Height:
State: FL.
ZipCcde: +}9SL2 Fax: '17,4 33S 146A
Phone No. 3a3'2
E-Mail' (L4Stqjr fq (P ao I r,m
State or County License: Cfl C 0 5 )R !O - She '
Commencement is required.
1.
NEER:
Name:
Addres
City: _
Zip: _
FEE SIMPLE TITLE HOL
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
Zip:
Not
_Not Applicable
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that nttoo� work or installation has commenced prior to the issuance of a permit..
which is to conflicmt with any applicabletHome Owners tAssociationl rules authorize
bylaws or and covenants that may restrictt 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 our Notice of Commencement
Signature of Owner/Agent/ Lessee
Signature of Contractor/L cense Holder
STATE OF FLORIDA, /i Z�
COUNTY OF_ C/�
STATE OF FLORIDA
COUNTY OF j o-
The forgoing instrum nt was acknowledged before me
this day of 27�c20,e�Z by
The forg ing instrument was acknowledged before me
1
thiseV. day of i{/zy 20 / by
71cc
(Name acknowledging)
(Name of person acknowledging)
/ooff-person
(Signature of Notary Pu Itc- a of Florida)
Personally Known OR Produced Identification
Type of Identification Produced
(Signature of Notary Pu lic- St f Florida )
Personally Known �OR Produced Identification '
Type of Identification Produced
Commission No. L" — CHRIS7INEB.
�ocp / (S MYCOMMISSION
EXPIRES:AP6
0VX!WT�Bydget
NGLISH *�°s:"'411 OHRISIINEB.FjyO
EEWMission NoE�/���%�/ * MYCONMISSIONtEEO
4.2017 a EXPIRES:A
$Mtn 'aanm'� grwdewd � Pri14,20
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.