HomeMy WebLinkAboutBuilding Permit Application 'I
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II tt��
Date: Permit Number: 1 ' Vw�o
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 C/
PERMIT APPLICATION FOR:
PROPOSED II�IPRQ�/E(�/iENT I.®CATI'�N::
Address: �� / "�� CC L
Legal Description:
Property.Tax ID#: Q ��� �G f' �c,O 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
FMLD DE5tRI'PTION 0'F WOR+K:
C®'NSTRUCT O. INFORMATION:
Additional work to be per orme un er this permit–check all tat appy:
Mechanical —Gas Tank _Gas Piping _Shutters Windows/Doors
Z,,Llfectric —Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ J Utilities: —Sewer .—Septic Bui1lding Height:
OWNER/LE.�SSEE: CONTRACTOR:
Name en C_C. Name: /9�Zw
Address: Ste/ LA_ CCA{� q r�
,2.�cY Company: S�r✓ ���c �2 . e:f�
City V �: 'P�r�2 Stater Address: a) ; cam. �z�
Zip�Code:. ,S Fax: Y6 �l �� 3 City: State:/.
Phone No. r' "'�"' Zip Code: ��Y� Fax:
E-Mail: S' 76-e60—7-e–,/ec_�nic (:Z�, u /•e;vwi Phone No
Fill in fee simple Title Holder on next page(if different E-Mail 57',l ou F (-(&._ i-•z Q o /-coon
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I�L CONSI"RlJ'C1"f®N LIEN LdAW" INF�JRI�/IATIO'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: 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
commencipzwork or recording ou Notice of Commencement.
4ourigcaner/Lessee/Contractor as Agent for Owner na ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _? COUNTY OF .
The forgoing instrument was acknowledged before me The forgoing instrun ent was,a nowledged before me
this day of 20n by this Sday of 20 )'�by
(N of person acknowledging) (N of person acknowledging)
(Si atur of Notary Public-Stat f Florida) (Si ure of otary Public-State of 0I,rida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. Seal)
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