HomeMy WebLinkAboutBuilding Permit Application ,PPLICABLE INFO MIDST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED �/'�
Date: ��..'J e '7'-'AK Permit Number. 1`�v� 1
Building Permit Application
Planning and DevelopmentS&Wces
Building and Code Regulation DivrSlan
2300 Virginio Avenue,Fort Pierce FL 34982
Phone:(772)467.-x.553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: a��acl �a i���T Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
117J t Gal C'IAPsc
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Additionai work to be performed under this permit-c ec all that appy:
_„_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:
Name d �nepName: L'�Lrtts S
Address: 13i, At- Company: A 'r
City: PC/P" ,kaayo(R Qe Address: iws SI- vi r
Zip Code: l 7- ?, A Fax: City: C te State: F
Phone No. 'T5 . . -- -- ---- Zip Code: 9502 -... Fax: `77 335-16,-
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: C&aT'113-1f, acd S CIO 1.6m
frons the owner listed above) State or County License: CA C 0:5.18
If value of construction ls2W or more,a RECORDED Notice of Commencement is required.
7 �4 -
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name
Address: Address:
City: State: lefty: $tate:
Zip: . Phone: �. . Zip: Phony:
EEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name% Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIiDVIT:Application is hereby made to obtain a permit to do thework and installation as indicated.
I certify that no work or Installatlon 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 guild 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,l do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Bulldipg 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 recordine vour Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Molder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF S—F L-uC10 COUNTY CIF,. T Gtr Cr
The forgoing instrument was acknowledged before me The for sing instrument visas acknowledged before me
this.ltd _day of_._l .20 by this, day of_�' for 4_ .20 ,�lb
t 7',s 'IFA rn eon �.
(Name of person acknowledging) (!Name of person acknowledging)
(signature of Notary Public-Sta of Florida) (Signature of Notary Public State of rids)
Personally Known VrrOR Produced Identification Personally Known PI/ OR Produced.Identification
Type of Identification Produced (Alt Pa.. �1lKilType of identification Produced
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Commission No. a1) EXPIRES:Aprs14,2017 Commission No. t�"�'S/���- w � mYCOON�#EE
r� Aaf� 9onoeo lhm Budget Nclsry s '+s 6dEX IRM APri14,20f
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REViEW
DATE
RECEIVED
DATE
COMPLETED
-Rev.