HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: r �7 Permit Number:
RECEIVED
Building Permit Application FEB � � 201
Planning and Development Services
Sudding 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: '
Legal Description: .sHLIKI FF 04 z L CST 2.0
Property Tax ID#: Z ;36) Cb0 6::�,G oOC) z Lot No._i?=
Site Plan Name: Block No. ��TT�
Project Name:
Setbacks Front, Back: Right Side: left Side:
&,t12_4- /9 Z , ��i 2-4
itiona wor to a pe orme un er t is permit—cheCK all that appy:
_Mechanical w Gas Tank _Gas Piping Shutters Windows/Doors
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_Electric _Plumbing _Sprinklers Generator Roof y Z Pitch
Total 5q. Ft of Construction: -Z S Sq.Ft.of First Floor:
Cast of Construction:$ od c'� Utilities: _,Sewer _Septic Building Height:
L Name 1 X011 Name: /n1 l�
Address: OCA Company: 1� r� l o
City; , .State:�` Address: Z�S S c�rtc�s� L V 1
Zip Code: G �O Fax: City:?�a.����-�a� _ _Stater
Phone No. -bZ) Zip Code: �3 3 ZZ Fax; �6-�h�C77SS
E-Mail: Phone No 9 15c-1-`/_�5 -yv7,3
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or county License
If value of construction is zs00 or more,a RECORDED Natice of Commencement is required.
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 w til 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 pasted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contralctor as Agent for Owner Signature of Contra or Ocense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1�Asn' COUNTY OF
Then instrum�gt was acknowledged before me The forgoing instrument was acknowledge me
this k day of 20 I 1 by this ' ` day of 1� � _—20 by
(Name of person acknowledging) (Name of person acknowledging)
4,1
(Signature of Notary Public-State of Florid ) (Signature of Notary Public-State of Florida)
Personally Known OR ProducedK4yiT&Moersonally Known OR Produced Id ga"fr�les Ellis
Type of identificatio 99 ype of Identification
Produced i w P Notary Public roduced 0 pG _. Notary Public
4;1&-e- to of Florida z State of Florida
Commission No. ea ommission No. (5 )..
IZA7y Commission �Commission
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