HomeMy WebLinkAboutBUILING PERMIT APPLICATION,,IPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
//1'-1617Permit Number:
Date: 7
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Cc) U lT Y
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
)ERMIT APPLICATION FOR:
address ,V,& ' �`
,egal Description:
Building Permit Application
Commercial Residential
933'"��/��C�/%` '�Lot No._—
Property Tax ID #: Block No.
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
/ We /Zlr- 11t/te, /.sT"'t /s—SPer CAAhsc- Jut -�-`t11
doves
/Doors
Gas PipingShutters _ Win
'Mechanical — Gas Tank _
Electric —
plumbing — Sprinklers — Generator _ Roof
— g
Total Sq. Ft of Construction:
Cost of Construction: $�
Name
0,
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Address: 437✓L��'
City: She �� Yie I vn z "�!e�, _ State:
Zip Code: i A n2C�'
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name: Lur f : S Sam e n -5
Company: i AA5T(oY11 �!J S ie c-
Address I l S S I Dr
State:
City: Po z i Luc kc- 335 1 �i6
Zip Coder Fax: h7;
Phone No. 77,2 3L-3L'2-
E-Mail:
L"3L'2-
E-Mail: �-'40 1 .
State or County License: c C D 5 I !O -
If value of construction is 25810ror more, a RECORDED Notice of Commencement is required.
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Name:
Address
City: _
Zip: _
NEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
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 dr 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 or recoro;,,g your Notice of Commencement 4
Signature of Owner/ Agent/
STATE OF FLORIDA
COUNTY OF :# r
The forgoing instrument was acknowledged before me
this day of 1 20_ by
(Name of person acknowledging)
ea--ee �
(Signature of Notary Public- State lorida )
Personally Known OR Produced Identification
Type of Identification Produced
nm
Commission No. C� * MYCOMMlSANil
EXPIRES::4, April 4,
f�'JeoF F`d°�4 BoMad Thru Budget Notary
REVIEWS FRONT ZONING
COUNTER I REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA p���.
COUNTY OF �l
The forgoing instrument was acknowledged before me
this day of —T r , 20 i - by
(lee J
(Name of person acknowledging)
(Signature P lic- Stat f Florida )
Personally Known OR Produced Identification
Type of Identification Produced
E�!S'yai��c) MY COMMISSION # EE 8592
mmission No. * EXPIRES: April 4, 2017
Bended Thru Budget Notary Ser"
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW