HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICAB E INFOUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:It
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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 cid
PERMIT APPLICATION FOR:
PROPOSED 1!NPROUE(UIENT L®CATI®'N:
Address:
Legal Description: �. � �j /� rz�rfz
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: I—jg,Q
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR;I10111
PTI(3N tF W®RK•:
-
CO'NSTRUCTI@ IN�F®'RMATII"
Acid itiona I work to a pe Orme un er t is permit —check all that appy:
M echanical _ Gas Tank — Gas Piping _Shutters ` _.Windows/Doors
Electric Plumbing Generator = Roof Pitch
_ —Sprinklers _
Total Sq. Ft of Construction: Zig 74- Sq. Ft. of First Floor;;
Cost of Construction: $ El ®B 1 DU Utilities: " Sewer —Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name: 1 (z
Name L r- l t, dG
Address: X
Company:
City: State:F
Address:
City: State:
Zip Code: G ,2 Fax:
/,
Phone No. �72 l4_;2_k '/
Zip Code: Fax:
E -Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E -Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
�UPPLE11lIEN1�AL COIVSTRIJCi'I®N LIEN LAW INf®R,IUfA ION.
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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 applioations•are exempt from undergoing a full concuriency.review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory rises 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=
Signatur of Owner essee/Contractor as gent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA, `
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrumTnl was ackn wledged before me
The forgoing instrument was acknowledged before me
this ay of 20� oy
this day of 20_ by
�� ► 4 l
(Na of person acknowl ging)
(Name of person acknowledging)
(Signature of Nota y Public- State of Florida) "
(Signature of Notary Public- State of Florida )
ersonally Known OR Produced Identification
Personally Known OR Produced Identification
Type i
yp
Type of Identification
Produced ANGELA M HUFF
Produced
3 a #o Notary Public - State of Florida
=• * * •; # ��
Commission , ®f* - ^ _: Commission930730
Commission No. (Seal)
'�,oav�o,.•� . Expires ay 27, 2019
Bonded through National
Not Assn.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014