HomeMy WebLinkAboutBuilding Permit Application.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Permit Number:
Building Permit Application
Residential
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
PERMIT APPLICATION FOR:
Address: '� C-'
Legal Description:
Property Tax ID #: .3 Li 2)'�
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
—1Nlechanical _ Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
.5 "vor,\
LA aQ�G .b(.!)
— Gas Piping
_ Sprinklers
Shutters
Generator
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
Name N��3 C e Q sr—
Address:-AL:) 7—�LLY�11 IA CI Q
City: �� State: F�
Zip Code: Fax:
Phone No. :! l2
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
Name: �Urtl5 So.arnmon �
Company: A « Sa S)'e
Address: 1( l S S 6 T1 1(0-a
City: VD -c ST Luce State:>cL,
Zip Coder Fax: _` 7,1 33S I tb F
Phone No. 3 23 '2-
E -Mail:
E -Mail: C fi - 01.
State or County License: CA C O 5 I 10 s- )L�
If value of construction is 2 60'or more, a RECORDED Notice of Commencement is required.
71100 -
DESIGNER/ENGINEER:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Signature of Contractor License Holder
Name:
Address:
The forgoing instrument was acknowledged before me
Address:
City:
State:
City: State:
Zip: Phone:
(Name of person acknowledging)
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Personally Known � OR Produced Identification
Name:
Address:
?o •••., pCIVIIS
Commission No. �>�/ * * MYCOMMISSION#EE
EXPIRES; April 4,
Address:
City:
M EXPIRES: April 4, 20
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City:
Zip: Phone:
ZONING
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
commencina work or recori;kVR your Notice of Commencement.
V,
Signature of Owner/ Agent/lessee
Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY OF 371 C LSC i �' _k
STATE OF FLORIDA
COUNTY OF '5e Lo k e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _(4L day of 2011e by
this _k.)_ day of 20 l k by
(Name of person acknowledging)
(Name of person acknowledging)
q
(Signature of Notary Public- State of orida )
(Signature of Notary Public- State of Flo w)
Personally Known L--' OR Produced Identification
Personally Known � OR Produced Identification
Type of Identification ProducedHype
of Identification Produced
?o •••., pCIVIIS
Commission No. �>�/ * * MYCOMMISSION#EE
EXPIRES; April 4,
�pRY PUg� CHRISTINE B. ENGL!
5�284mmission No �G� ����`f rMY COMMISSION#EE 85
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'v 4,.3
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M EXPIRES: April 4, 20
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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. 7/2014