HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 x
PERMIT APPLICATION FOR:
PROPOSEDINPROUEMENTIOCATION
Address: 2/l �`'1�/�a.4'J@� %i�C7 010'17 5T .��.�- �� 3 V9s'a
Legal Description: A112 C42aS �z
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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71DETAlLEDIDES;CRIPTION�OF WORK h g� ur � �, ff r � yr , 1 � �
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Additionalwork to be pe'rformecl under this permit-check all that appy:
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric -Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer _Septic Building Height:
N"T,rR'ATOSS
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Name Name: / a
Address: Q11 C4/Ll/;Uc) e)�1 ti2j-d Company: �iiGc�t4 � 'e ee
City: A471 J7r /_t t .b Sta-re: C/ Address: / (1(, 4042e2222 Gc;^
Zip Code: 34 45— Fax: City: '-&T State:
Phone Nof���� 3n 2 7 Zip Code: .3 5.3 Fax:
E-Mail: Phone No(VM) 9Y2-A?Q13
Fill in fee simple Title Holder on next page( if different E-Mail '16 69 60 l! d
from the Owner listed above) State County License',
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S:11 P�EI\/iENTALC®NRCtCl'I®N LI'EN�LAUU PN{F®R'M�T
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
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-)/our Notice of Commencement.
Signature of Owner/Lessee on Tactor as Agent for Owner Signature of Contractor/ icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S I V G`� COUNTY OF
The forgoing instrume t as,�cknowledged before me The forgoing instrum t was acknowledged before me
this Q_; day of - 20AI by this P-3-day of CF 2Q1)-by
(Name of person acknow a ing) (Name of person acknowledg'`gam
(Signature of Notary Public- a of Florida ) (Signature of Notary Publ' -St a o/Florida)
Personally Known Vc-'1 �.Q �q i ILLO Personal) Known ",YP�'' d .SE AESNILLO
,g •duced Idiip� y C!� e�dnlb#��'ts6� �°date et Flarlda
` ��; Notary Public a e o9 F16fida s2 0 0�s Y
Type of Identification =°n Type of Identification _.; m.__ Commission#FF 184850
Produced `° °E Commission#FF 184850 produced
���* 'a`� Comm.Expires Dec 22,201
, Comm.Expires Dec 22,2018 OFF"
Ronde throw h National Notary Assn. "����� ` Bonded through National Notary Assn
Commission No. Commission No.rk
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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