HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST,BE COMPLETED FOR APPLICATION TO BE ACCEPTED ro
Date: 66-1?–iJ Permit Number: OZ�T
IF
--- -- _ 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:
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Address: L000 0 56E to D 2 TE 6/606,6_ 6Z YgK77,
Legal Description: I_QT_ t& S 0G2o ..4
Property Tax ID#: 3465 901 bo to 000? Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: .• Right Side: Left Side: -
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itiona wor to epe orme under� t "is permit–check all that appy.
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: �77_&V Sq. Ft.of First Floor:
Cost of Construction:$ 71.O Utilities: _Sewer _Septic Building Height: %D R'
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C? .- ECES
RAS' F #CQlT CTOR � � s
Name 1 °– 4LAWAAM J A2 Name: ST-c-vC_P3 riot, tUA :j
Address: 11123 e'S('Ciab4 INZ Company:_('A-r,'T-opoc,:A� eeoryj& Lu-,
City: j-r P(cgie�- State:11 Address: 32`71. Ave
Zip Code: 5q( i r2, Fax: City: 't Ptca cL State:
Phone No. `7'TZ ' 34 ( .-I-- Zip Code: :3t4C1 92- Fax: 7)2-�(ol-l�fEfS
E-Mail: Phone No '-r)-L 21 ;?0q7
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 6CGO5-S.S-`73
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. '53 r /��
S *PPM `TALt)NSTU� 1'®N :IEN W11QR AIt�N�
_ _
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
commencigg w or recor ' o r Notice of Commencement.
Signature of essee/Agent Signature of Co a r
STATE OF FLORID STATE OF FLORID + -
COUNTY OF COUNTY OF 1
The fo_ oing inst ent was acknowledge re me The-f L�Qing in ment was acknowledg d b fore me
this_Jay of 2 by this�c�'day of 20 by
(Name of person acknowledging) _ e of person acknowledging)
(Sig a of Notary Pu ' -state htFlorida) (Signature of Not P c-State of FI rida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission N ea 'ussy�(►eloN 1BUIMeN y6na41 papuog
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Iglpapuo Commission No slwwo0 `S�o
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