HomeMy WebLinkAboutBuilding Permit Application,�?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
_ Permit Number:
/.
Date:// / �—
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Building Permit Application
Commercial
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
/ll e /z�( 0)fe
Fonai work to be pe
Residential
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s permit - cNORPat t NappPy����
1 Mechanical _ Gas Tank _ Gas Piping
Lot No.
Block No.
Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ lj Utilities: —Sewer _Septic
Name U X a- -
Address: ro
City: �! - - - State:
Zip Code:Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Roof
Building Height:
Name: L'urtt5 SaY on S
Company: C(AsTL>7�- Lc S,�.S toms )L C'
Address: i( I S S E Ti I D,
City: V,,e-T ST Luc ke- State: FL.
Zip Code: 349&1 Fax: `7'7,7 LE I 2L
Phone No.
E -Mail: Lus-fAjr SC c
State or County License: Cfl C 0 5 I R l0 s42-1
If value of construction is l or more, a RECORDED Notice of Commencement is required.
s
Not
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: Name:
Address: Address:
Com' 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 abylaows or and cove antes thatt may rthe
estrict or prect ohibit such
which is in conflict with any applicable Home Owners Association rules,
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 ersevi another noew: room n -residential dentia) use
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory twice for
WARNING TO OWNER: Your failure
Notice a Nome of
must be recordedment result
uand p steur el paying, twice
tw j e for
site
improvements to your property.
before the first inspection. If you Intend to obtain financing, consult with lender or an attorney before
commencing work or recorAR Your Notice of Commencement. .-. w
MORTGAGE COMPANY: — Not Applicable
Name:
Address: State:
City. Phone:
Zip: -
BONDING COMPANY: Not Applicable
Signature of Owner/
STATE OF FLORIDA1 io -
COUNTY OF C� �l
The forgoing instru t was acknowledgedd before me
this r--- day of 2001, ) by
(!ah"' Tr m rno n-�
(Name of person acknowledging)
(Signature of Notary Public= Stater lorida )
Personally Known °/ OR Produced Identification
Type of Identification Produced
oto"Y.P"ecCHRISTINE B. ENG
Commission No.��5'
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETED
Signature of Contractor license Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument wa acknowledged, before me
this ;'i day of �G 201" by
(Name of person acknowledging)
(Signature o4Notary blic- ate of rida )
Personally Known AOR Produced Identification
Tvlse of Identification Produced
MY COMMISSION # EE oc
EXPIRES: April 4, 2011
SUPERVISORI REVIEW
NS
REVIEW
C/ MY COMMISSION # EE 8;
No. EXPIRES: April 4, 20
Bonded?hn. Budget Notary Si
VEGETATION I SEE I� E MANGROVE
REVIEW REVIEW