HomeMy WebLinkAboutBuilding Permit Application 'iAll APPXICABLE INF MUST E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:.. � s Per
a DI� mit Number:
�u
KA
J��
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)4624578 Commercial Residential
PERMIT APPLICATION FOR:
LO
Legal Description:
Property Tax ID tt �7L�/^�"� 4y� ot�� � J No.�_
Site Plan Name: Block No.
Project Name: ka f ,0 kA qP
Setbacks Front Back: Right Side: Left Side:
r._ a u
ing;
WON ,
_ s
Mona worktobepertormed under this permit–check t.at-ilPply
_Mechanical _Gas Tank _Gas Piping i :Sh tters _Windows/Doors
�lectric —Plumbing _Sprinklers `' s rC xG erator _Roof
Total Sq. Ft of Construction: S . Ft.ofFiht loor:
ost of . struction $:, / - S �' d� Utilities:. 94ver _Septic Building Height:
Name Name: '' �'�T GEct2GG`
Addre IL Company:
City: I State:_ Address:
Zip Code: Fax: N City: Stateef:
Phone No. �2. - I Zip Coder Fax:�� C6 Z�
E-Mail: Y if mr 10,11Y Iao-Cc� Phone No.410S7
Fill in fee simple Title Holder on next page(if different E-Mail:
y,6 -� LG–`i�7cLLCo2� �g�9�1��h'J
from the Owpe listed above) State or County License:
% ,I Ioti� �V►�e- C
1 alue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
;:i mom
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 o.sted on the jobsite
before the first inspection.If you intend to obtain financin with lender or attorney before
conmenci ork or recording our Notice of Comm ement.
l
v
Signature of Owner/Agent/Lessee Si na=FLORlb
or/L' ense Holder
STATE OF FLORID STA
COUNTY OF 0COUNTY OF i
The forgoing instrument was acknowledged befor •.��� The for oing i, e t;7 acknowledged before me
this day of �� 20�S by , 5b this f ay o (1�t2 205 by
M)IIiMlk�
(Name of person acknowledging) a (Namrope son acknowledging)
0 N
ie..� to G
( i atu a ofrn
lic-State of Florida) o>>„ (Signature of N ary Public-State of Flo�;ilW I'll Hill�j/
Personal) Kn " mOR Produced Identifi t11w'0 = Personally Known ✓ . OR Prod' ed;
Type of Identification Produced — d Type of Identification Produced *: '�'a`t�•a
Commission No. (�('®70 3�g' (Seal) Commission No. ?J J �.►; ' ($rr �z ;*_
' e99�e r�, � �•Q.
��.o'.2yFinaedlh+u ; ��
��9✓e STAT �F ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TUR/�'L�'�'Ml ;MXNGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
-Rev.