HomeMy WebLinkAboutBuilding Permit Application Date: .�D lv ,�� Permit Number: /5/0• X41
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Building Permit Application OCT 26 20b
Planning and Development Services
Building and Code'Regulotion Division
2300 Virginia Avenue,Fort Pierce FL 34.982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential 1'
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Property Tax ID#: " J — 0 Lot No.I__
Site Plan Name• Block No. _
Project Name: jQn -
Setbacks Front _ Back: Right Side: Left Side:
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�ACIORIOnal wor oe e Orme un er ispermit-c ec a appy:
HVAC 1..Gas.Tank - DGas.Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ -¢� utilities: Sewer5eptic Building Height:
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Name _ Name• 6z'� ��'//�? S
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Address: 1. r%� �. Company;
City; / - Stater Address:.
Zip Code:"' �� :1: Fax: City: ,lState: .
Phone No.l_; � ��r� 7�� /PZ� D_ . Zip Code: "� � Fax: /
E-Mail: Phone No. 12;79 ��/rP
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Fill in fee simple Title Holder on next page(if different E-Mail: 7n�r)lYTR 5,-iC-
from the Owner listed above) State or County License: S'
if value of construction is$2500 or more,a RECORPED Notice of Commencement is required.
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DESIGNER/ENGINEER: 4ZNot Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: .___. State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: of Applicable BONDING COMPANY: _ of Applicable
Name: Name:
Address: Address:
City: City:
Zip:...__._ __ __ . Phone: Zip: Phone:
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,l 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.
S
_ Ignature of Owner/Lessee/Agent S' nature of Contractor License Holder
STATE OF FLORIDA `���_ur, I� COUOF OF
FORIDA
COUNTYOFSr- 2-C-1c /IEE
The forg instrument was acknowledged before me The for instrument was acknowledged before me
thls� day of_( �v QG'� — 20 �Eby this day of ( 7��Ba~"7L ,20/ by
h_ `Oh'/1'y9_'NA✓ sA^lm-" •
(Na cknowledging) (Name of person acknowledging)
me of erson a
dz..I- 464zot vjt�w 040- 4wytna'��
gnature of Notary Public-State of Florida) ignature of Notary Public-State of Florida)
Personally Known 2S:-' OR Produced Identification Personally Known _OR Produced Identification
Type of Identification Produced Type of Identification Produced.... .......
Commission No. lssion No. HOHMANN
'����"�' SANDRA HOHMANN _
` a ? :�'•� No Public-Stale o!Florida
a°� .fig= Notary Publle-State of
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Revised 07/15/2014 •''�o,r. `' Commission N FF 071680 ° "„�,�� Bonded7Tua,ghNaBona-0
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i. w►N Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW- REVIEW
DATE
COMPLETE
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