HomeMy WebLinkAboutBuilding Permit Application.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date: 1 __ ,
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Building Permit Application
Residential
2—
commercial
Address: '../ Lji4e)n L05 ' ,
Legal Description:
�l
Property Tax ID #:� jy - 00D Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Gllc��� t✓1h� 3 �' �� �dsu� ��rst a q
AdclitionalworKTODepertormeaun er Is perm - c ec a t a app y:
'M echanical _Gas Tank _Gas Piping _Shutters
Windows Doors
_ Electric — Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Z�/-� t Utilities: _ Sewer _ Septic Building Height:
Name [ t-
Address:_!`{y I�� }-'I-c�� ►'jy`,��Z c_.'<
City: iIM rtik CL4- r State: I�
Zip Code: Fax:
Phone No. '77 J 66 9 -
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: eurtl5 Sa vnmon S
Company: C,,As � r LP S fe
Address: I( I S S 6 `) 1 U' r
City: '��S T Lk C k C. State:
Zip Code: 34 Fax: '7a
Phone No. 772 336' "32-32
E -Mail: C fi 01
State or County License: CRC 0t5 IR 10
If value of construction is2 eO'or more, a RECORDED Notice of Commencement is required.
700D
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not 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 or recori;WVg your Notice of Commencement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor license Holder
STATE OF FLORIDA
COUNTY OF J7I1
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of No it emb e. r 20 ; ! by
this day of mti Qc 20JL, by
T / --; GV" 1712e)4-5
(Name of person acknowledging)
(Name oT person acKnowieaging
A V'i 4
'/
Z' �"6
, - , , --� '/
-"
(Sigrfature of Notary Publi State of Florida)
(Signature of Notary Public- State of Florida
Personally Known OR Produced Identification
Personally Known d- OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. i -i ��� 7.j ea` � DEBRAL
tommission No. I I .�•� %:i i�*��-��'�`'(S�Y�10N��75
rt * MY COMMISSION t
EXPIRES;
227575 EXPIRES: Septert�er 5, 2019
5, 2019 "�,
�fx*� ry
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 712014