HomeMy WebLinkAbout Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Y i A-4 1(S Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Port Pierce FL 34982
Phone: (772) 462-1558 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: -741t)6)
Address: i
Legal Description: h� � La —610 LQ9 Lo
Property Tax ID #: L7j - (p I to 052
-�' Lot No.
Site Plan Name: Block No. 1
Project Name:
Setbacks Front Back: Right Side: Left Side:
amonal work
-Mechanical
Electric
pertormed under thispermit-c ec a
Gas Tank
Plumbing
Total Sq. Ft of Construction:
Cost of Construction. $
Name
Address:
City:--DO--11-0
GIN,
Zip Code: _-',)f)bLe_eT Fax:
Phone No. —
Gas Piping
Sprinklers
apply:
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: —Sewer —Septic Building Height.
! e:Y t/
State: (
E -Mail.
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: j CUYIA-75 fin s 4� t�i4/
Company: '� �. �� CbD k '���
Address: & ISO
:r
t
City: �4-_ State: H
Zip Code: Fax: —
Phone No -7 - 33-7'7
E -Mail cz_r,)I -,11._\ 6�cai'r . C.9_"
Sta`I or County License C'. ( 9 i (P'5 ?
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DE5IGNER%ENGINEER:Wotpplicable MORTGAGE COMPANY: lot Applicable
Name:
Name
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _'cit Applicable BONDING COMPANY: ✓IGot Applicable
Name: Name: —
Address: Address:
City: City:
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 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 work Wecording your Notice of Commencement.
r/ Lessee/Agent
of
e Holder
STATE OF FLO/�
:. J U . f &�ORIDA
COUNTY OF
COUNTY OF
The forgoing instru)Tient was acknowledged before me The forgoing instrurAent was ackwledged before me
this dayof 20 &,by this, dayof `u ,� np201&by
r� 4 rl .
'lir' c
(Name of person acknowledging ) I(Name of person acknowledging )
0%%% 111 I ffffe
(Signature of Notary Public- State of Flori ) : �. a 0
SR13RIf�, L. PLA =�ra�`` ��:
�.�
Personally Known OR Produced Fawlificip 327i
Type of Identification 4"60
. c
Produced Ge'.:l�h�d�
,'1'1 41C ST
Commission No'. F1!-_ 7 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
�Signatur ry P bli - S f Flo,
personally Known +f OR Produced
,�`ype of Identification
Produced
Commission 1�1�0. F�?
L.
� ��.ptUalY?,�oy.���
t4i kation 0
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DATE
RECEIVED
DATE
COMPLETED