HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: r 1S I I La Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3498.E
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: i�lc
Address:
Legal Description: T%l tom- L.0 +- iG
o
Property Tax ID#: i�q A � � -7� d ' � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
iaitvon I work to be performed under this permit – check all that apply:
�fMechanical Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing — Sprinklers — Generator
Total Sq. Ft of Construction:
a
Cost of Construction: $
Name 1 Y Vii
Sq. Ft. of First Floor:
Windows/Doors
Roof
5670 • – ` Utilities: —Sewer _Septic Building Height:
Address:wL y�
City: L (2 V N I? State: j;,
Zip Code: y7uQn I Fax:
Phone No.91-1 - 3D-7 • a(te) .AS"Y(A
E-Mail:-N1 4 -
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: 71c-,� 'L rem
Company, &`V-75 I
Address es n5L:-0Ia—
City: %NG e— Stater
p Code: �t49 -2— Fax:
Phone No 77 _ 52 7 .3-3 -7"7
State or County License /0,5
11 Va]U= VI LlVI ]LI ULLI II M Z -:)VV Vr more, a Krs-uKuru ivoxice OT Commencement is regwrea.
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
Commencing war r recur our Notice of Commencement.
Si re of er/ Lessee/Agent
STATX-�OF FLO
COUNTY OF a�bL-t✓ k
The for inst. J.: nt was acknowledged before me
this `) day of . c� % 201 by
Y), JJ
(Name of person acknowledging
i t f o r if o r tate of Floridtateeof'F'lloo-rid
' I`�I 1 QyIJLX
Personally Known L"'O" OR ProduceipMr,
Type of Identification
Produced
Commission No. FF 1 �
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
ctor/License Holder
*It OF FLORI
UNTY OF
The forgoing instru .ent was acknowledged before me
this day of 20J-Lby
(Name of person acknowledging)
C
L �� �/P// (Signature of Notary Public- State of Florida) �e��.,tt �mA L, a
le.,8L4 •' /jam SABRINA L. BLACK.
Personally Known OR Produced Id if-"*" D �
>il °'O `�w� Type of Identification _ 4m
�.40 — Produced*
#F 19 7'P.�� �•° #FF 195337
4nd9d��t'� -"zip: Commission No.C'
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SUPERVISORPLANS VEGETATIO
REVIEW REVIEW REVIEW
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SEA TURTLE
REVIEW
MANGROVE
REVIEW