HomeMy WebLinkAboutBuilding Permit Application .?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: `�"�� Permit Number.
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Building Permit Application rLf-
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:
Legal Description:
Property Tax ID#: v � �117` _� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ME
Additional work-to be pertormed 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: Sq. Ft.of First Floor:
Cost of Construction: $ / �' Utilities: _Sewer _Septic Building Height:
Name Name: LUrtts Sc_vnmcn -5
Addre : lge'2,2u t JId,,- M'Y, Company: ak1 TM R c'r S11S f eMS )AjC.
City:_ ��Z�d /ly-GG��d ��d A1,6 Statey� Address: (l I S S E Ti 16 g,2.Q ae A D/- -
Zip Code: Fax: City: POP--T ST Luc�e_ _ State: rL.
Phone No. -F'72 973 ('St 5 , Zip Code: 49-",I Fax: 179J3,5- )U E
E-Mail: 0_.haMP_0A&% n,6�1 -Cee c._: Phone No. 77- 53,E -U32-
Fill
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Fill in fee simple Title Holder on next page{if different E-Mail: J i?A•I Q r4'15 C Ize Q��e .`t , JUA*
from the Owner listed above) State or County License: CO C D 5 IR 10 - S�C'Je
if value of construction is25eU'or more,a RECORDED Notice of Commencement is required. i
75-00
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DESIGNEE 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 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
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commencing work or recordiiilig your Notice of Commencement.
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Signature of Owner/Agent/lessee I n a cense Holder
STATE OF FLORIDA STATE OF FLORIDA -
COUNTY OF COUNTY OF eA e�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Y_day of 26A by this Yday of O.a4 2Q 19 by
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If T IS %_�#L_'01 0),
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub State rida
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(Signature of Nota Public-Vfte of Florida) tKo
Personally Known OR Produced Identification Personally Known VOik Produced identification
Type of identification Produced Type of identification Produced__,
JSH 411:a.EWABI-1
IyYCOMMISS01EE Commission No. OCCOMMMI,
LPS23-")N#EE 859284
Commission No EXPIRES:April 4,Z017 EXPJR7.Z�A prit 4,201.7
DoMall"Budgi0"
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
I COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED ------- UIH
1017
R
DATE
COMPLETED
Rev.7/2014