HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO M ST BF-COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 1 Permit Number:
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:
PR®'P®SED INP'ROUEM'ENT LOCATION:
Address: (3/06
1 f
Legal Description: 0 /7 f b23 hl &�?IeTf
Property Tax ID#: �yX' / "`�✓ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILS� DE�SCRIPTI®'N OF WOR+K:
IrC.%"N,7S]'TfR,T,-UMC"Ti�g.,N INFORMATI'®N:
Additional work to a-performed under this permit—check all that apply-,
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator t-_Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ r �,L(✓�r '90 Utilities: —Sewer _Septic Building Height:
0 NER E�SSEE: CON T 01
R:
Name Uil1 /� �S"�`7 Name:
Addres : d u� Company:
City: 1111ell State:_ Address:
Zip Code: Fax: /� City: State:
Phone No. �� — �6 7`- Zip Code: Fax:
E-Mail: a caTR CO/'a') Phone No
Fill in fe simple Title Holder on next page(if different E-Mail
from the Owner listed above) I State/County License
If value of construction is 2500 or more,a RECORDED Notice of Compr1encement is required.
SUPPLEMENTAL C®'NSTRtUCTI®N LIEN LAIN I'NiF®RMAI'ION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: I-"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 thepermit 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 recordin , olAr Notic _of Commencement.
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Signature of Owner/Lessee/Contractor as Age t for Owner Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF ki--C�J�- COUNTY OF
The rgoing instrumas acknowledged before me The forgoing instrument was acknowledged before me
e w
this ay of 201_F?by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
'
Seal
Com lssian,l�,o. (Seal) Commission No. (Seal)'
ANGELA M HUFF
on a
Commission 7
REUIEVUS� ^> rF;RO�1T.Expin A SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
J 13
CO.U,N_TERiv�, RME,W,, REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.