HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INFO LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� 4 1� Permit Number: 1 V
n
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:
PR@P@S@Q l�L\IPR®$VEMENT®L®CATI'0'N:
"Address: 35-0"6 f VL-
Legal Description: S- y_y_4 JL_ V_teC L
roperty Tax ID#: �d ��� 000Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
®'ETAILED DE�SC �P�.0. . OF W�O�R"K:
Ftv\h �n Gr��,�- F ShL�
CONSTRUC I'0, INFO M'ATION:
Additional work to be performed under this permit-check all that appy:.
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors-
_Electric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.,of.First Floor;
-Cost of Construction:$ I S' �. Utilities: —Sewer —Septic Building Height:
OWNER/LESE`t : `CONTRP►CTO';
Name 14(% It 16 g`. Name:
Address: `� `�� I� VL- Company:
City: C-o r�r V t(NP--- State: �-F Address:
Zip Code: "J Lk °I 10 Fax: City: State:
Phone No. '-I 7 - 4 HO y a Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
L L
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C•0'NST00fie I®N LIEN LA11V INF®:R{MMT10
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 recording our Notice of Commencement.
�l
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA // STATE OF FLORIDA
COUNTY OF � Ll���e_. COUNTY OF
The forgoing instrument was acknowledge efore me The forgoing instrument was acknowledged before me
this day of 1" 20J_4 by this day of ,20_ by
/k r- \ ( � � e, �)' es k-y"l)
(NapxR of person acknow edging) (Name of person acknowledging)
(Signature of NotUry Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati Type of Identification
Produce Produced -
A ornv P`e(i�i M HUFF
'_• Notary Public-state of FI Commission No. (Seal)
Comm s3i * ._ $bI
missiorr
.7 FF 234730
My Comm.Expires May 27,2019
Miami Notary Assn.
REVIEWS FRONT ZO I G SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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