HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
"IM,
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:
PRCIPOSED INPROUEMENT LOCATION
Address: / o'`Z
Legal Description: 7 2S �4d A/ go,— _6
y yy <I,3 v /,7Yoe
Property Tax ID#: 12 d2 O Lot No.
Site Plan Name: Block No.
Project Name: 0,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK k!�'
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GONSTRUCTIQN INFORMATION
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _'Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: Sewer Septic Building Height:
01NNERjLESSE CONTRACTOR" � RM
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Name 04 S/rName: 6
Address: Company: d (1,,
City:4�P Plc State:vr Address: 5 M;&Vee_
Zip Code: =L Fax: City: State:f
Phone No. l} x Zip Code:?tV- Fax:
E-Mail: '' Phone N7 7.2-
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Fill in fee simple Title Holde"r,'or�,next page ( if different E-Mail 0,
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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
commencin work or recording our Notice of Commencement.
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S,gfiature of Owner/Lessee/Contractor as Agent for Owner Sign e of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��s COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this S day of 2n–) by this day of (YL 20D by
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(Name of oerson acknowledging} (Name of Urson acknowledging)
nature of Notary Public-St e of Florida} (Signature of Notary Public-State lorida}
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
V1_ O � '�1 • �O•t �l�o�k C� (Seal)
Commission No. (Seal) Commission No.
AS AHNA INGRAM
REVIEWS FRONT a n l0iotary PS PEf�tLMSORo ida ANS VEGETATIO ``PF E{ U g (r� da
COUNTE � !y con m.!RE�IE�F 20, 01R VIEW REVIEW � - _�tla y Pu li
DATEGomm.Exp rUN&E�2u't,2018
Q:: commi Sion#
RECEIVED 'r�°��" Banded �roughAationalNatary ssn, P�°
Bonded thro ah National Notary Assn.
DATE
COMPLETED
ev.7/2014