HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETE' `OR APPLICATION TO BE ACCEPTED
SCANNED Permit Number:
Date: � — I _ � I � BY
5t. Lucie Ccfunty ��
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 VVV
PERMIT APPLICATION FOR:
Address: 4J / Z,&, '96-7�
Legal Description:
Property Tax ID #: - 7 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
aitlonal worKto ne perrormea un
Mechanical Gas Tank
permit — cnecK a
_ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:,/
Cost of Construction: $ 7i�0& U
Name I?WA12d, a /&
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Addresss:v,'`Ige;X.
City4 LiAz vxs State: ✓h
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Cur
Block No.
Windows/Doors
Roof
Building Height:
Company;,.WsTe.KY1=�•'`Alr 5!4Sfe-MS )Ai
Address: r'een
LState:
Zip Code: 34g5�j Fax: qU J3S 1 �6
Phone No. 77d- 33s -3)-3,2-
E-Mail: C.Itstaor su 5; V ao)-L,cm
State or County License: _ Cfl C 0518 !O Sla�e '
If value of construction is2.5Wor more, a RECORDED Notice of Commencement is required.
.'k
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 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_
Signature of Owner/ gent/ Lessee
Signature of Contractor/L cense Holder
STATE OF FLORIDA O
STATE OF FLORIDA
�f
COUNTY OF ��
COUNTY OF zez_e_�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this r day of 20 /ff-by
this J_ day of 20 >-by
71f LI,4�inorrS
slollw1imi-,
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary P/ulic- Sta of Florida)
(Signature of Notary Public- Stat Florida )
/
�
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced .
Type of Identification Produced
Op' N/ CHRISTINE B. ENGLI
Commission No. LCEO c��g�0 T # I MYCOMMISSIONIIEE85,,mmission
EXPIRES:
�p p �°S:lly P%/ CHRIS7INE B. ENbLISH
No. �CO�Ig��Ll * °al `
� �fy COMMISSION 9 EE 135g�q
April 4, 20
srq oA`O� Bonded ihN el Motes Se
7 N. EXPIRES April4, 2017
is s "re oc��°P
•
N'/ eNiCPs
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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