HomeMy WebLinkAboutBuilding Permit Application All APPLICABLIf INFO fVIUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: C)
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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
PERMIT APPLICATION FOR:
PROP®SE® INPROVEMENTTbRE ION
y s
Address: V\,
Legal Description:
Property Tax ID#: 0I �) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�., MnSri
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C®'NSTRl1C��TIO�N I:NF�O.R�11/fATfON°: a
Additiona work to be per Orme un er t is permit-check a tat.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:$ S ��A�1 Utilities: Sewer _Septic Building Height:
OWNER/LESSEE: C®.Kun A1.
Name Name:
Address: ' 'e- [% Company:
City: �iPAL State: Address:
Zip Code: Fax: City: State:
Phone No. — C) Zip Code: Fax:
E-Mail: c Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State ounty License
If value of construction is 2500 or more,a RECORDED Notice of C mencement is required.
11PPLEE�IENTAL C�NSTRilJ�TI®N LIEN LAIN I?NFOR+MA1"IC?N: p
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
improve nts to your property. A Notice of Commencement must be recorded and posted on the jobsite
before t e irst inspection. If you,intend to obtain financing, consult with lender or an attorney before
comme ci work o record' our Notice of Commencement.
Si natu e f Owner/Lessee/Contract s Agent for Owner Signature of Contractor/License Holder.
S E OF FLORIDA STATE OFTLORIDA
COUNTY OF COUNTY.OF
The Jogoing instrumowledg efore me The forgoing instrument was acknowledged before me
this day of MW6
20� y this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
1
(Signature of NotaN Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known 0 Qduced Identification_Z Personally Known OR Produced Identification
Type,of Identificatio n Type of Identification
Produced,,. Produced
Commission No S 1) Commission No. (Seal)
ANGELA M HUFF
E`� s° u•- Comfmi Sion# FF 234730
REVIEWS ,;r�. Pf AOITComm.E'ZPNIWa27,2 J PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
CC�UNgE�RthroigR1BVdiEalulV6taryA sn. EVIEW REVIEW REVIEW REVIEW REVIEW
DATE r-�.—
RECEIVED
DATE
COMPLETED
Rev.