HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO M]LU/ST BE COM
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QED FOR APPLICATION TO BeACCEPTEC, a
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Aiunoo aion� 'IS Permit Number: Ign�
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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: Q603 Lv►7_! LLkmmoG1C
L&n e,
Legal Description:
PropertyTax ID #: ZII so)
o00 3 000 1 Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
,lJCIA,
�dW4r /0I-2�
Additional work to be pertormed under
c ec all that apply:
this permit -check
Mechanical Gas Tank
Gas Piping Shutters Windows/Doors
_
_ _ _
KElectric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 6 ®Ci , 0o Utilities: —Sewer —Septic Building Height:
Name kf. r n
Name: QACL G ear.
Addresses� Lanz o�rn
L IiN-
company: 0,q �ileEUN 6-1,ec ('r rc, U-C.-
City: r-u f1i
State: F(,
Address: 1305 W, i S iree+
Zip -Code: °� Fax:
City: F(jle f nLrc,e Stater
Phone No.
Zip Code: 3yg fr z Fax:
E-Mail:
Phone No. •772'41
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License: a UI
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
i
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 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/License 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 Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. (Seal)
Commission No. (Seal)
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DATE
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Rev. 7/2014
All APPLICABLE INFO MUST BE CON, TED FOR APPLICATION TO BE ACCEPTEE,
Date: Permit Number:
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
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Address:
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Haaitionai worK to De perrormea unaer tnis permit — cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
...
n
Name
Name:
Address:
:.Company:
City: State: _
"Address:
Zip -Code: Fax:
City: State:
Phone No.
Zip Code: Fax:
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:
I 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 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
comm—encing work or recording our Notice of Commencem
Signature of Owner/ Agent/ Lessee
Signature of Contractor/License Holder
STATE OF FLORIDA /�
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The f gang instrpTent was acknowledg, d efore me
this lS day of 20 by
The-f oing instr ment was acknowledged b fore me
this day o 20Aby
(Name of person acknowledging)
(Name of person acknowl g' g)
1 0,?'I,�
75'A
ignature of Notary Public- State f Florida)
(Sign of Notary Public- State of Florida )
Personally Known OR Produced. Identification
Personally Known OR Produced Identification
Type of Identification Produced _
Type of Identification Produced
_
DAWN MILONE
Commission No. )� :<� - a;{Sedldtatry Publlc -State of F
Ann, No. .�u
ILONE
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2017 ? 2; �'
Public - StateFloridaCommissionof FI
Mrvotary
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REVIEWS
FRONT
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VEGETg _11", ;
aW t�WR E
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
;SEA�fdiln44atl
" IZEVI�➢17R
DATE
RECEIVED
DATE
COMPLETED
Ev. 7/2014