HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll -APPLICABLE INFO MUST BE COMIz,:'ED FOR APPLICATION TO BE ACCEPTED (; (�
Date: SCANNED Permit Number: q Q py'
Luc � sy
county
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
PERMIT APPLICATION FOR:
Address: s t?o
Legal Description:
Residential
Property Tax ID #: 3l4o,2 O 3 - 009a r0690 -- / Lot No. Y/ Y2.
Site Plan Name: Block No.%
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lff t- ,402 Z /tl-e &C- Zia) /io /6 Se e 2
oitional worK'
'Mechanical
_ Electric
perrormed unaer
_ Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ a00
permit - cnecK all tnat apply:
Gas Piping _ Shutters.
Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Windows/Doors
Roof
Building Height:
Name v,v-1 4" 6�2/(
PC
Name:,4
Company: ` Ileff 1� � c_ C -
Address: 0 ,'�e e h17.
City: r te
Stater`-
/n!
Address: 4011.3 GAS,02
Zip-Code:-3 Fax:
City: pc ert� State:
Phone No. (J r0�oloZ
Zip Code: 3 Nef P Fax: ;)2a VAf-. O,91
E-Mail:
Phone No. '7a-
E-Mail: f
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: -`-Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 roorris 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 Comm encem nt.
Oz�
dr/L/ C
i nature of Owner/ Agent/ Lessee
S' ature of Contractor/License Holder •.
>.
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF �-
The fcrf9ing instrum t was acknowledged b ore me
this ay of 20� y
The forgoing instrument was acknowledged- � efore me
this day of 20� y -
(Name o rson ackr Owledging)
(Name of a son ackno ledging
1
(Sign-aftnf4leWotary Public -State of Flori a)
(Signature of Notary Public -State of'Flo 'da )
Personally Known ORFProdt ca, derrtifi
Personally Known OR Pro dt�ddentifica`t o
Type of Identification Produc d 'O.—I` _'� DAWN MILO
p'of Identification Produced Cj ' �,* r L.. NE
u lio---State of FI
- g� •' h1
=� + Y omm. Expires Mar22,
Commission No. ;9� ��{Sea
rids �� MY Comm. Ex irestate Ma of FI
mission No. '%;FOFF�o; eal om p 22,
�q �$ mis
���,
of F J;•• ommission # EE 8775
Bonded Through National
��� Sion # EE 8775
� Bonded Through National Notary
Notary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
,COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
-Rev—.7/2014
,
IN