HomeMy WebLinkAboutBuilding Permit Application ,PPLICABLIE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: AD -e6'-I!' Permit Number:
II III
Building Permit Application
Planning and Development Services
Building end Code Regulation DIWslon
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)4k-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: �_;flel_ldwel 64�
Legal Description:
Property Tax ID#: 7_0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�onaorktobeVerfdrmed under this permit-check all that appy:
wmechanical —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:$ Utilities: Sewer _Septic Building Height:
Name x Tr rd Name: eurtt$ Somrn, n s
Address, Company,_Ca�&m A-(,r st4sffms )AJC_
City:•_ State: L Address: . IW,5 S& 921 16QA' Qr-&A Dr -
Zip Code: Fax: City: P097 ST LAgie cl -)
State:FL.
Phone No. Zip Code: Fax. qM 335
E-Mail: Phone No. 7 3 z31
Fill in fee simple Title Holder on next page if different E-Mail: —g-ust
kk)r s u ,Q 1,r,m
from the Owner listed above) State or County License: CA C 0 z ,?/0
if value of construction is2SWor more,a RKORDED 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 covenants that may restrict or prohibit such
structure.Please consult wdh 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 fork
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
commencin&work or recor$og your Notice of Commencement.
'Signature of Owner/Agent/lessee Signature of Contractor license Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Se Pu�� COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_ day of t�� v 20/S by this-���day Of ��o ray 24,/,S: by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-Stat of Florida) (Sigh Lure of Notary Public-State Fldelda)
.Personally Known'� OR Produced Identification Personally Known OR Produced identification
Type of Identification Produced Type of Identification Produced
Commission No. C��S9a�s� MYCOhiM SIONNEE9 86ommis'sion No. 4?- 6� QWZc! ` `�"` %RiSTWE&EN(iM
- - li EXPIpES:Aprp4,291 - * I�MYGOMId1SS10NiES859
04 a Thn,Bd10ko lyl ce EXPIRES:Apr94,2017
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REVIEWS FRONT ZONING. ' SUPERVISOR- PI ANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW' REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED '
DATE
COMPLETED
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