HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f% // % 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 _X
PERMIT APPLICATION FOR:
Address: 5 Do
Legal Description:
Property Ta,x ID #:
Site Plan Name:
Project Name: Ai
Setbacks Front.
P
l;
0
Back: Right Side: Left Side:
Lot No._
Block No.
Aaaitionai worK to ne pertormea unaer tnis permit– cnecK an tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors
�' Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor: 1�
Cost of Construction: $ 300, Utilities: _ Sewer —Septic Building Height:
®11NIVE4R/LESSEE:
CO. TRACT OR:
Name Loli G
Name:
Address: 5009 �jGt��P--r, �
Company:
City: 94jet a— I Stater
Address:
Zip Code: Fax:
City: State:
Phone No. 00— o10 y_(2 -E;!F
Zip Code: Fax:
E -Mail: Ay m
Phone No
Fill in fee simple Title Holder on next page ( if different
E -Mail
from the Owner listed above)
State or C my License
If value of construction is 2500 or more, a RECORDED Notice of Commenc€ment is required.
SLJ�ly MET,MENTAL CONSTR1U
T1®N LIEN LAV1/ INFORI�IATI®N:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
STATE O%F FLORIDA
_
Name:
Address:
COUNTY OF
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Personally Known OR Produced Identification
Name:
Address:
Type of Identification
Address:
City:
City: I
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 your Notice of Commencement.
r-4 '��
Signature of Owner/ Lessee/C tractor as Agent for Owner
Signature of Contractor/License Holder
STATE O%F FLORIDA
STATE OF FLORIDA
COUNTY OF �5�=�i�
COUNTY OF
The forgoing instrum n was acknowledged before me
The forgoing instrument was acknowledged before me
this day of � 20��by
this day of 20_ by
a �3"�A Lohol
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary ublic- ate of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identific tion
Type of Identification
Produced
Produced
PRV P,,B, ANGELA M HUFF
Commission No. ����° .; Notary Publi(eS tWe of Florida
Commission No. (Seal)
= • •= ommissior # FF 234730
9,F,
oPSr My Comm. Expires May 2 •� ''
ndedthrough Nationa
Notary Ass„ ;
REVIEWS
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PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //LU14