HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:ill.}23 J 2Q1i..p Permit Number:_
Building 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 APPLICATION FOR:
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Legal Description:SbefCl-\-oO ]>\aw -Uri\~One..-Lot-15 (De.olD -2/132')
PropertyTaxID#:\431-roO\~OD\B -ODD -C6
Site Plan Name:_
Project Name:_
Setbacks Front _
Lot No .---DolS""'--__
Block No._
Back:Right Side:Left Side:_
o Windows/Doors
DRoOf
Total Sq.Ft of Construction:__::--_
Cost of Construction:$J-tD5'D o~
S'f-£!;of First Floor:
Utilities:USewer DSeptic Building Height:_
Name])rohl~t-\b..:....\\-=o--;'MQ.,:::=-=..::....('\"---____uel t.r
Address:\\a :Bed~~fd~'b=.....c...(_\....;'__~_____Company:t A-tc.0+the.TreLEU([
City:=tOr-\-:P \erce..State:n..Address:[POI S.14 rlhe--t.Itvenue...
Zip Code:~4Q41o Fax:City:ftr-\-;V,erce State:FL
Phone No.'1 Y(2-Y'lo l -.34D2...Zip Code::J.l9lD Q.Fax:172 -Lite ~~LfS-
Phone No.1'12..-LUo 5-HotlP
E-Mail:achl D.n-t-ctgever D\\b (ill hmrro:.\.C{)rY'
tate or County License:()\t 0.3£1.~loq.it::8<3
E-Mail:_
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is $2500 or more,a RECORDEDNotice of Com men
DESIGNER ENGINEER:_Not Applicable MORTGAGE COMPANY:
Name:Name:~~_
Address:Address:--=-_
City:--.,,.---State:City:-:::-:-State:
Zip:Phone:Zip:Phone:_
_Not Applicable
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 structurewhichisinconflictwithanyapplicableHomeOwnersAssociationrules,bylaws or and covenants that may restrict or prohibit suchstructure.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
commencin work or recordin our Notice of Commencement.
FEE SIMPLE TITLE HOLDER:_._Not ApplicableName:_
Address:_
City:-----,,.---_
Zip:Phone:_
I ature of Owner!Agent!lessee
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The for~<Hnginstl:~,.'~entwjls acknowled~efore me
this 23!....dayof l'\0 ("eh ,20lli£j by
Dflrnlje!T :DlIrh,vj(
(Name of person acknowledging)-.......
Commission No.__~~---!•.•.••~
Revised 07/15/2014
_Not ApplicableBONDINGCOMPANY:Name:_
Address:_
City:._
Zip:Phone:_
Signature of Contractor/license Holder
STATE OF FLORI:('7 .~I .
COUNTY OF ~/rn UtCIGJ
The forg~ing instrument was acknowledged before me
this 2.3!-day of mllrch ,20[0by
Gn'll/eJ .t.fA .
(Name of person acknowledging)
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(ignature of Nota;?b·-Stat~"<5 riHqJ *?0..~~........~~~'!;-v ••'tJI'IR£s ••~~
Personally Known o~",#~~~ntifici\j~
Type of Identification Producelu i!!J :;,/lc 1~'6i=2 .~a:J •W 2 'V._~~:o ~~~~§:l!:~Commission No..:::;~••p;n (~;:t!l#'"~~~.-1'4 ~1:tS ••c.,~
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REVIEWS SUPERVISOR
REVIEW
DATE
RECEIVED
FRONT
COUNTER
ZONING
REVIEW
DATE
COMPLETED
PLANS
REVIEW
VEGETATION
REVIEW
SEA TURnE
REVIEW
MANGROVE
REVIEW