HomeMy WebLinkAbout1604-0050,?P,LICA LB E INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Permit Number.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Lot No._.
Property Tax ID #: / `{ J Block No.
Site Plan Name:
Project Name: Left Side:
- � B A— Right Side: __
a
v' Mechanical
Electric
Total Sq. Ft of Construction:
Cost of Construction: $
Gas Tank
Plumbing
Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
Name ' ~�
Address:
State:-. L
City: -/a
Zip Code: �5�1`y� Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Nam
Lrtts So vn
on
Ric
Sl1Sfe
>uc�
Company:
usTMrn
T i
t •
Dr '
Address:
.n ��
c, T i Lke
State: ��-
City:
34 �S�
Fax: 971 33S 1 i6
Zip Code:
Phone No.
E -Mail:
C fiq r
o . I .
cm
State or County License:
Cfl C 0 5 I
10
If value of construction is^2,5e0'or more, a RECORDED Notice of Commencement is required.
Not Applicable
Name:
Address: State:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Phone•
MORTGAGE COMPANY: ,Not Applicable
Name:
Address: State:
City:
Zip: __Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
dip.
OWNER/ CONTRACTOR AFFIDI 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..
ect
Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
St. Lucie County makes no representation that is granting a permit will
authorize
deed forranty hestnctions which r to build emay,apply. ru structure
which is in conflict with any applicable
structure. Please consult with your Home Owners Association and review your that I will, in all respects, perform the work
In consideration of the granting of this requested permit, I do hereby agree
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications
fences, exempt
f rom un screenroomsand accessory uses to another nog a full concurrency review: room n -residential use
accessory structures, swimming pools,signs,n twice for
WARNING TO OWNER: Your failure Record a
tice CommNoticencemene of lt must be recordedencement uand posted ongthe jobsite
improvements to your property. A
before the first inspection. If you Intend to obtain financing,
cosuit with lender or an attorney before
commencin ' work or recor our Notice of Commencement. n
Signature of Owner/ Agent/
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of. • 20�, by
Signature of Contractor License Holder
STATE OF FLORIDA l�f��l
COUNTY OF�
The forgoing instrument was acknowledged before me
this day of 20_ by
(Name of person acknowledging )
Zld�it�
(Signature of Notary Public- tate of orida )
Personally Known _ ; OR Produced Identification
Type of Identification Produced
MY COMMISSION # EE 859
Commission No. cc # n EXPIRApril 4,201
�r9�nt R4g3P Banded 1Mu Budget Notary Ser
(Name of person acknowledging)
(Signature 4NotaryPubli State lorida )
Personally Known OR Produced identification
Tvoe of Identification Produced
REVIEWS FRONT ZONING S REE/REW R I PLANS
REVIEW
COUNTER REVIEW
DATE
tWcf
No. �E /l / �:
VEGETATION I SERA�i�LE
REVIEW
CHRISTINE B. ENGUsr
COMMISSION # EE 8592
* E'c:)IRES: April 412017
MANGROVE
REVIEW