HomeMy WebLinkAboutBuilding Permit ApplactionAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (0 l l n h(o Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 91nb I :::�'tzxnQ4
Legal Description 1>
-12 r C'L
__T_kre.e
Property Tax ID #:1�1_f - r,-5Lot No.r�
Site Plan Name: Block No.
Project Name: �S�lY�2n►�Yl�
Setbacks Front Bach.' Right Side: Left Side:
.Y'6 14- o -P -5 --I-bn1 If 5
C+4e� J i1(4--) I 4�LID hem
er this permit -
Mechanical _ Gas Tank _ Gas Piping
_ Electric _ Plumbing
Total Sq. Ft of Construction: _313 9
Cost of Construction: $ fiq S '15�
Sprinklers
apply:
Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
Name Slip �-tSt�h'IQ�rT Name: ' '*0 rig r -<U
Address: c i _ 4' company: 1 fQ 9' c'/jn l
City: -�- p wc'o State: �L_ Address: 1 1��L'4n�-rV PI t31 a
Zip Code: Fax: Cit --!PE'<* Stater
Phone NoCI'>� C -II- (a L -,"59 o(D Zip Code:L- 'Itg L_o Fax:
E -Mail: Phone No.( '1 ;� IkL� % - 3 4 Lf
Fill in fee simple Title Holder on next page ( if different E -Mail: D
from the Owner listed above) State or Count License:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
IN
_ ENlENTAL CONSTRUCTION LIEN LAVA
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 or recording yo r Notice of Commencement.
Signature Qf Owner/ Agent/ Lessee Signature of Corptiet<for/License Holder
STATE OF FLORIDA,
COUNTY OF 1 - 1 i u&'Q
TheforgQing instrument wasacknowledged before me
this f ay of (,YrtYl6at, , 20JX by
(Name of perso acknowledging
(Signature of Notary Public- State of Florida )
Personally Known �tlrM�i
Type of Identificatio rq,t iI pfRORAH RUSSELL
"p Notary Public State of Florida
Commission No. Com�i,,Vn N FF 179830
%',;o,F�o?;••` My Comm. Expires Nov 30, 2018
STATE OF FLORIDAq,
COUNTY OF TA . (_r � l',' P_
The for ng instru ent was acknowledged before me
this _G -ay of �ysb0ti , 20ALoby
(Name of p acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known
Type of Identification Produ d VP •o. nEgnaAH RUSSELL
;
Nota Public - State of Florid
Commission No. (Sei3gission # FF 179630
•'••' of FAQ' My Comm. Expires Nov 30, 20'
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014