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HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED }� 2q, Date: Permit Number: /1� 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: Address: JI Legal Description: Property Tax ID #: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: aitionai worKto tie perrormea unser. _Mechanical _ Gas Tank s permit — cnecK a Gas Piping Electric Plumbing _ Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ Q0L-4 • a Shutters - Generator Sq. Ft. of First Floor: Utilities: —Sewer _Septic -Windows/Doors Roof Pitch Building Height: OUIINER/ E1S�SEE: C©NTRAOTTOR: Name1014i Name: / Address: ��/,s' ?, ,✓� cSl' Company: Address: . '001 - City: State: Zip Code: Fax: Phone No City: 114;i �l�c� State:.�L Zip Code: Fax: Phone No. Xtx - ' SZ -3,3o_5 E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E -Mail State County License If value of construction is 2500 or more, a RECORDED Notice of Compiencement is required. IRRELEORIUTATI®N: 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: roomadditions, 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 commenciniz work or recordine vour Notice of Commencement. Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA C �— STATE OF FLORIDA COUNTY OF COUNTY OF The forgoing instrue t was cknowledged before me The forgoing instrument was acknowledged before me thisay of 20by this day of 20_ by (Name of person acknowledging) U _ t (Name of person acknowledging) (Signature of No ary Public- State of Florida NJ (Signature of Notary Public- State of Florida ) Personally Known OR Produced Identification Personally Known OR Produced Identification Type of Identificatio , Type of Identification Produced Produced ``�1pNV i �i A HUFF Commission ! Cf.n « � : Notary Public - St ��e otl lorlda Commission No. (Seal) ;. „ * •; lsslon # F�%4730 o,(�F My Comm. Expires May 27, 2019 REVIEWS 7 R NT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW , REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.