HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial
Address: 0�_ ?
/
Legal Description:
PropertyTax lD #:'
Site Plan Name:
Project Name.
Setbacks Front Back: Right Side:
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Left Side:
Residential
Lot No.
Block No.
L
- - — - I. -T - — —11 1 —
Mechanical Gas Tank
,Z.Electric Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
3ermn - cneCK au tnat a
Gas Piping Shutters
Sprinklers Generator
Sq. -Ft. of -First Floor:
Utilities: Sewer Septic
Windows/Doors
Roof
Building Height:
Address- 4—Y Vil,!
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City: State:
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Zip Code: .409-40 Fax; . C ty I— State:
City: &A
Phone No. Zip Code: Fax:
E -Mail- Phone -No -)
Fill in fee simple Title Holder on next page if different E -Mail 111-4 C/ ?-2 4� Q AVL or 60 r,,i
from the Owner listed above) State or Co-u/nty License %JON'l
If value of construction is 2S4O or more, a RECORDED Notice of commencement is required
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable MORTGAGE COMPANY:
Name:
Address:
Mate: City:
Zip: Phone:
_
Not Applicable BONDING COMPANY:
Name:
Address:
City:
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 bolder 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.
4� ?. A-, 3
Signature of Owner/ Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forkoing instrument was acknowledged before me
this �' day of *Kt 20
(Name of person acknowledging)
(Signa ure of Notary Public- a e`of Florida
Personally Known OR Produced Iden
Type of Identification
Produced
Commission No.
(Seal)
REVIEWS FRONT ZONING
COUNTER REVIEW
BATE
RECEIVED
DATE
COMPLETED
2ev. 7/2€14
ca p
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Baa
STATE OF FLORIDA
COUNTY OF,~
The forgoing instrurri ntw s acknowledged before me
this 3 qday of CA , . 20� by
1
(Name of person acknowledging)
(Signature of Notary Public- State of Florida j
Personally Known __ OR Produced
Type of identification
Produced
Commission No.
a
(Seal)
SUPERVISOR IPLANS VEGETATION SEA TURTLE
REVIEW REVIEW REVIEW REVIEW
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