HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MUS BE CO LETED FOR APPLICATION TO BE ACCEPTED
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- 578 mercial Residential �►
PERMIT APPLICATION FOR:
Sam
Address: "6Q /, i
Legal Description: .4o'zl '20
Property Tax ID#: 3,Y62 6 Lot No. . 2 0
Site Plan Name: Block No. 5;7_
Project Name:
Setbacks, Front__�27 Back: 7.2 . Right Side:3 Left Side: /6. ?
a
006 ' J7
rtioork to Be performed under this permit–check all that appy:
_Mechanical _Gas Tank _Gas Piping —Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: /1S1(� Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
Name Name: C'1.
Address: A�wc?'g`', ��r� `;;�.�r-`. Company:
City: � ,,�:� - State-W Address: ?o�/S
Zip Code: 3!K A?Z Fax: City: State: All
Phone No. 2 8 V– Zip Code: Fax:
E-Mail: Phone No 7�2
Fill in fee simple Title Holder on next page(if different E-Mail'—
from the Owner listed above) State or County License /4 Y 7 8
�1
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 covenantsthat 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. -
00
Signature of Owner/Lessee/Agent Signature of Contractor/Li-cens6 Holder
STATE OF FLORID r p STATE OF FLORIDA l
COUNTY-OF �� ,( `� COUNTY OF � [-��.CL 4p—
The f rg ing instrument wa ackn wledg d before me The for instrument s acknowledggd ore me
thisiay.of 20 y this y of . 201 by `
(Name of person acknowledging) (Name of person acknowle Z91
(Signature of Nota Public- tate of Florida) (Signature ofNotPublic-State of Florida)
Person en i tart oPe
n ronally KnowssOR Produced Identification:
e o JAwN ILMMViAP
Produc d, y r Produc e ANGELA A HUFF
ay 2 7, pC3F�Publl�State f_o
fldgmm, xpr -2'J 19
s= 0mmissla*FF 2347
Commi iori""ifoP+pPI ' e Comm! i-ares May 27,
9npded;tbrai iqh National,Notary Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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