HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLQ INFO MU TBE COMPLETED FOR APPLICATION TO BE ACCEPTED
f _
Date: G `9 Permit Number: G
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: ,�O/
Legal Description:
Property Tax ID #: C�
Site Plan Name:
Project Name:
Setbacks Front Back
Right Side: Left Side:
Haaitionai worK to oe pertormea unaer tnis permit— cnecK an tnat apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric LZ lumbing _ Sprinklers _ Generator
Lot No. 11r9 7
Block No. Iqll
_ Wiindows%Doors
Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _00— Utilities: —Sewer _Septic Building Height:;
01NN6R LESSEE
CONTRACTOR 4r'r ^ M 'F
Name
Name:
Company:
Address:
Address: ,
City: �� State: �
Zip Code: 3 CI Fax:
Phone No. 222— %0 - S 7 9
City: \
Zip Code: Fax:
Phone No
State:
E -Mail: a-P&I j ak tido Cv^'-
Fill in fee simple.Title Hol41/1 n next page (if different
from the Owner listed above)
E -Mail
State or Cou, License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
VIENTAL CONSTRUCTION LIEN LAW
INFORMATIONS PIM; _
�f
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 ins p ction. If you intend to obtain financing, consult with lender or an attorney before
corKimencinglVvork oTTecording your Notice of Commencement.(100
Signature of Owner/.Lessee/ tractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF fit, COUNTY OF
The forgoing instr as acknowledged ia�fore me The forgoing instrument was acknowledged before me
t is�( da of r;� 20 � by this day of , 20_ by
(Name of person ackno a ging) (Name of person acknowledging )
�1
(Signature of No ry ublic- State of Florida (Signature of Notary Public- State of Florida )
GE A M HUFF � Personally Known OR Produced Identification
Personally' no�v,�ni'P�-, ORA��R�ug�r�lg��q$Mary g ,ion Y
Type of IderLt► e �__ � FF 234730 Type of Identification
Commi
Produced ay 27, 2019 Produced
Bonded through National Notary Assn. "
Commissio�l -'regi) Commission No: (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW .REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.