HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INF MUST E COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1
M,
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: i.
PR{®P'OSED INPR�OVEMENT LOCATION:
Address: .J r 95 % — ZD�
Legal Description:
J' I
Property Tax ID #: z4la Lot No.
Site Plan Name: Block No.
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Project Name:
Setbacks Front Back: , -– Right Side: t Left Side:
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DETAILED D SSC tIPTION OJ=@R K:
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CONSTRUCiI®N INFO'RMATI�ON:
Additional work to be pertormecl uncler this permit– check all that app y:
_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: $ e� a Utilities: —Sewer —Septic Building Height:
OW ER/ROOM I
MTRACTO'R:
Name ALA70 th-2,EYEC Cz
Name:
Addr-ess:,�51_ �� "�iij /L
Company:
City: F71 �( L�� L° L State:(,
Address:
Zip Code: Fax:
City: State:
Phone No.�� �//Q ? c'� ��� q
Zip Code: Fax:
E -Mail:
Phone No
Fill in fee simple Title Holder on next page ( if different
E -Mail
State or County License
from the Owner listed above)
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUIPPLEM1,ENTAL C*O,NSTR',UCTI®N LIEN LAW INFORfMATI®'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: x 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
commencine work or rec- yr e vovT Notice of Commencement.
Rev. 7/2014
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA I'
STATE OF FLORIDA
COUNTY OF ,�"� � L C A
COUNTY OF
me
The forgoing instrut was acknowledgedbp
The forgoing instrument was acknowledged before me
this day of 20 by
_nn
this day of 20_ by
CDL r\ G C
(Name of person acknowledging)
(Name of person acknowledging )
M " UA
(Signature of No ary Public- State of Florida I
'
(Signature of Notary Public- State of Florida )
OR Produced Identification
Personally Known 0A P ced I e if' a n
Prsonally Known
of Identification
Type of IdentificatZh ,• !; P �, ANGELA M HUFF
UB`�=
pe
Produced �✓ �I ��
Notary Public - State. of -Florida
lfXoduced
} 2 • : w • Commission # FF 234730
r
ommission
Commission No. ;N9� o�°� rvog® m. Expires May 27, 2.0
No. (Seal)
Bonded through National Notary As
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014