HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: „`�
1\.� Permit Number: I �So G-C)q o
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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: d.
Legal Description: 2-217-6
Property Tax ID#: �p07 0 r . Lot No.
LkSite Plan Name: o c.,�h cl o iCeclrr'eP� L 0.d e j-C.2,r. f-!4 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
JDie�, o- 6 J5c2- OSS
itiona wor to a pe orme un er t is permit-c ec a t at app y:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
u�
Cost of Construction:$ (7 Utilities: —Sewer _Septic Building Height:
Name v kJ-%X �C Name:
Address: 0"1;:: i.o4�7�- � :...Company:
;City: - ;�t State: Address: 701 &C
Zip Code: Fax: City:,- t Z r �- 34R'qS State:
Phone No. Zip Code: o � Fax:
E-Mail: Phone No 1721 `(& (e�
Fill in fee simple Title Holder on next page(if different E-Mail r��-� �nA Cz>4-1_
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 thepermit 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:Y ur failure to Record a Notice of Commencement may res#in your paying twice for
improvements to your operty.A Notice of Commencement must be recorde and o ed on the jobsite
before the fir I sp on f y u intend to obtain financing, consul I h le d r or n orney before
commenci w k r re di our Notice of Commencement.
Signat Owner Lessee/Agent Sign atu o tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA \1
COUNTY-OF ��• � COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was.acknowledged before me
this ! day of e 20L5by this2e day of e_ 2016 by
aj
L
(Name of person ackno ging) (Name of person ac Oled )
c '
f
==duced
o orida) (Signat ic- to of Flc;n Identification Personally Known OR Produced Identification.
Type of Identification Type of Identification
Produced roduced
LISA L WHITE. r�~�•u` '- 1$A I.WHI`i'Q 4
Commission No. MY(6Oi4iM153ION#FFISS57 ommission No. IvtY CSI KiN Fel
'��Q• EXPIRES February 11;2019 EXPIRES aaPYd�l 11a. 1�
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014