HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COM"L;,'ED FOR APPLICATION TO BE ACCEPTED
Date: / ;k9t OD - /�S— qr� AN I Permit Number: 000/
I'YMU
BY
St. Lucie County
WAIM 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 Residential
PERMIT APPLICATION FOR:
Address: A F-1 A, "Or'- e
Legal Description:
Property Tax ID #: _3 VO 3 —Ko 0 / 2 9 —6 cicl `7 L o t N o. 2, -/-C" 12
Site Plan Name:.<d'-V4 Block No.
ProjectName:
Setbacks Front Back: - Right Side: Left -Side:
^" '/C -- A ee-- �-
Iclit[cmal work to be pe
/Mechanical
Electric
unaer
GasTank
— Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 000
permit - check a
Gas Piping
— Sprinklers
Name .5��A Ive. ,, e- C'6r
Address: gol,
City: , e-lftl' State:
ZipCocle: 33/29 Fax:
Phone No. 3 4
E-Mail:
apply:
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: —Sewer _Septic Building Height:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: tZ4 tme-r L,
Company: 5-;� "61e,',r ec"C'1'�, ", A,,,,
�2 r "- Az�U
Add ress: g2j? -zlc- &11-
City: State: /CY
Zip Code: 3 �j F2 — Fax:
Phone No. ZLZ -5-Z X- 3 37-?
E-Mail:
State or County License: rA� 1?16 f 7�F
It value ot construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGN E R/ENGI NEER: — Not Applica
Name:
Address:.
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone:
State:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
ate:
Not Applicable I BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifV that no work or installation has commenced prior to the issuance of a permit.
St. Lucie.�ounty 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
commi-nring wnrk nr rpcnrdinLy vour Notice of Commencement.
ature of Owner/396—t/ L&e'e
��gh—gt_ure of Contractor/ricense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this — day of 20_ by
this _ day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Florida
(Signature of Notary Pu blic- State of Florida
Personally Known OR Produced Identification
Type of Identification Produced
Personally Known OR Produced Identification
Type of Identification 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. 7/2014