HomeMy WebLinkAboutBuilding Permit Application .4PPLICABLE INFO MUST BE COMPLM!VOR APPLICATION'TO BE ACCEPTED
Date: Permit Numbern. IISC)<6
Buildinge Permit Application
Planning and Development Services
Building and Code(regulation Division
2300 Wirgh7io Avenue,Fort Pierce FL 3490'
Phone:(772)462-1553 Fax-(772)462-1578 Commercial Residential
PERMITAPPLICATION FOR:
Address:
Legal Description:
Property Tax 10 4z1L?,4-,r&-'Of��Z� 44Z9 IZ9 Lot NO.
Site Plan Name: Block No.
Project Name:
Setbacks Front_ Back: Right Side: Left Side:
Additional war kfob-e-krformed under this permit-c ec all that apply:
/'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:$ 3 00 Utilities., —Sewer _Septic Building Height:
Name 5Name: 9Lr—tis
Address..—grfi"z SV 4J� &Q company: Cu�-a,
-m At'r.5!4ste. S flu
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City: Stale- A-4 Address:-1�15 S I I tare r,.v& It
Zip Code: Fax., City: E.7- ST'L Lkete- State.L1...
Phone No. -,js.�'f - -9
Zip Code: Fax: q4
E-Mail: Phone No. 7,2 "3a3 2.
Fill in fee simple Title Holder on next page If different E-Mail, c-il %jrS!dtg Q01-(1=
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from the Owner listed above) state or County License: CA C 05 1?10
;
.4f value of construction Is 2&Wor more,a RECORDED Notice of Commencement is required.
z:—ro
DESIGNS ENGINEER: Not Applicable mORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
city_ State: city: State:...
Zip: Phone: Zip; Phonic: _
FEE SIMPLET=HOLDER: _Not Applicable S N VINQ COMPANY: ,.Not Applicable
Name: Name:
Address: Address:
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 cer*that no work or Installation bas commenced prior to the issuance of a permit.
St.Lucie Counttyy makes no repre entation that is granting a ppermit will authorize the permit holder to build the subject structure '
which is In cogict with any applicable Nome Owners As;r atian rule&bylaws or and covenants that may restrict or prohibrt such
which structure.Please consult with your Home owners Association and review your deed for any restrictions may apply.
In consideration of the granting of this requested permit,i do hereby agree that t will,in all respects,perform the work
In accordance with the approved pians,the Florida Buil ftf Codes and 5t.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 accessary uses to another non-residential use
WARNING TO OWNER:Your failare to Record a Notice*F Commencement My result in your paying twke for
#mrovements 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 recordina vour Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Halder
STATE OF FLORIDA STATE OF FLORIDA
cowry OF ST L-U C l e COUNTY OF;. c5T C,cs r e
The forgoing instrum nt was a owledged before me The forgoing instrument%vas acknowledged before me
this_(y,day of ,ZOLS by 'this + day of .ZQLI by
terr -
- _
(Name of person arcknovAedging) (Name of person acknowledging)
(Signature of Notary Public-Staioi Florida I (signature of Notary Public-State rida)
Personally Known OR Produced identification_ Personally Known '� OR Produced identification
Type of Identification Produced .�r��C a En Mg Type of identificat9on Produced
� * • gXf4i:017 Commission No. �tcArfoul41 �g
Commission No.
fly 19liPipE9:Ap�i4, # INCO<~MN$i0i�itl�
'�� 3ladrdTi�t�iidkf - ,�� EXPI�E&:Ap�'d.�^Ot
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEPI TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
v.7/2014