HomeMy WebLinkAboutBuilding Permit Application C
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
f Date: 1 ll� Permit Number:
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Buil Permit Application
Planning and Development Services MAR 11. 2O
Building and Code Regulation.Division
2300 Virginia Avenue,Fort Pierce FL 34982
�p Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
( PERMIT APPLICATION FOR:
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PR�POS�ED�iNPR�1A�EMEN�L�O�TIQN�
Address:
4 Legal Description-- !
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G Property Tax ID#: `�s-Fi �fa � -- Lot No.
Site Plan Name: Block No. C_ _
3 Project Name: u. a
Setbacks Front Back: Right Side: Left Side:
D >AILEDDESCRIPTI'ON 0'F WURI�: ' ,r
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itiona wor to a pe Orme un er t is permit-c ec a t at app y:
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:
OWNER/LESSEE
00 -E,
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Name '' Name:_
Address: C� w �� Company: ft_ i17r_*n"1J
City: (-�� ���- State: Address:
Zip Code: 54C�Q Fax: City`: L State
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Phone No. _7P4- 40R---'3 q t 5- Zip Code:_�5L41�\S CO Fax: 34LA -Cel<y-
E-Mail: Phone No. RGt r34t-r-"
Fill in fee simple Title Holder on next page(if different E-Mail: h '
from the Owner listed above) State or County License:
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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w-„,MMI:.
` SUP LE1�tE rAL CO SYTRUC�'I�'N tEN �1N 1 0� �.�
f DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
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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
k 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.
r In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects, perform the work
F.. 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
i commencin work or recording o r Notice of Commencement.
Signature Owner/Agent/Lessee Signature of Coor/License Holder
STATE.OF FLORIDA STATE OF FLORIDA
COUNTY OF - _ L C;c� COUNTY OF }- . L 49—
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1l2"� y of YY1 � ,20 p by this� ay of�Y��}�C1•� 20�by
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(Name of person cnowledging) (Name of perso a nowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known f
11,
UCOURAM nuao— t 1 'e of IdentificationlPrI °elsType of Identification Produced'”" R ;z,
=UQwYPU°`�': No ry Public State of Flo i °'« :•c My Co E Iles Nov 30,2018
Commission No. - ti tr SP Lission No. =Ns* °o;� CoAmn# FF 179630
*•4%vomm.Expires Nov 30, E Bonded through National Notary Assn.
Commission#FF 17M 0
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REVIEWS FRONT Z NG SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
. RECEIVED
DATE
COMPLETED
Rev.7/2014