HomeMy WebLinkAboutBuilding Permit ApplicationName:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
city -
Zip: Phone: _
Not
State:
Not Applicable
MORTGAGE COMPANY: ` Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip; Phone:
Not Applicable
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 build the subject structure
swhich tructurin e. Please consult withnpyourHome Owners Associationtandrrev rules,
deed for any restrovenants ictions wh ch mastricty apply obit such
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
commencing work or recording your Notice of Commencement.
Dr I
— � Z� - 9.& -
�ca�essee/Agent
STATE OF FLOR pp�
COUNTY OF ikl
The ginstrumentacknowledged bAme
this f—day ofIn2`yy
(Signature
Notary Public- State of Florida )
Personally Known V
Type of Ide
Commissio
.MY
,�
14C/� :f48-0'
Revised 07/15/2014
OR Produced Ident kation
i:YSTAL A QUEVEDO
COMM SSION 00904048
EXPIRES July 31, 2019
�0_ s
5 att�retyf£o a W/License Holder
STATE OF FLOR
COUNTY OF
The forgoing inst nt was acknowledg d before me
this,a day of 20 by
-iJkM 0
VW -
(Name oferson acknowledging)
T - &1d
(Signature of Notary Public- State of Florida )
Personally Known indt931.2019
ion
Type of Identification , : - _.
DO
•:
r M # FF904048
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
REVIEW
MANGROVE
REVIEW
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS
ALL APPLICABLE FANO MUST BE COMPLETED FOR APPLICATION To BE ACS
Date: 6 . )-f . i ('41- Permit Number:
Buffing Permit Application
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 APPUC4TlON FOR: Otho
Address: �9W S. L lam- 't . ::& lM 3
Legal Description: S I o- n
Property Tax ID #: 653S•• (a)2-0105-600- (.o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
un r is perm - a app :
_ HVAC Gas Tank []Gas Piping _ Shutters Q Windows/Doors
11Electric 0 Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: S.
Name
Sq. Ft, of First Floor. _
Utilities: 0 Sewer 0 Septic
Address: I 4aJ-�
city: 0-ameS LILL4 State: J%—Jl
Zip Code: t SR 3/ Fax:
Phone No.
E -Mail:
FII in fee simple Tide Holder on next page ( if different
from the Owner fisted above)
Building Height:
Name: N S&Y^)
Company: i
Address:
City: 'D l -i ate:
ZiR-Code: ')
/S 1 0
Phone -lam. `�� l/ 1
E -Mail: m
State or County Licens .
ff varhie of construction is$2500 or more, a RECORDED Notice of Comme,imment is required.
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