HomeMy WebLinkAboutBuilding Permit Application (2) S�UP'P `M�ENT L CONST lJr✓1'ION LIEN LAW INFORIVIATPO'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
commencin rk or,recording our Notice of Commencemen .
SignatLKe of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
4C L
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of C0QL&4 20n by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Sigp&ure-of Notary Public-State of F ida ) gnature of Notary Public-State of Florida)
\\ pSHAHNA iN�IRPA
Personal) Known o d-ldbati 'i S�ate'bE Ffo' onally Known OR Produced Identification
Personally Notar+� ti
Type of Identification ¢ti �y M.E pates DF 1772 dyef Identification
Produced * _ mmission ced
o1«'� 0�,; (Seal)
Commission No. ,auonalNotartission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.
' I
i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: it f.1� Permit Number: ! V M93
O - y
Building Permit Application
Planning and Development Services
Building and Code Regulotion Division -
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 • Commercial Residential
PERMIT APPLICATION FOR. P '
To Select from dro box, click arrow at,the end of line
'PROPOSEq'iMPROVEMENT LOCATt . IV:,.
Address:
Legal Description: CCi/VU
Property Tax ID#: dc -�dl'-'QCT -" Lot No.�.
Site Plan Name- - Lt/C1c/ '�` - Block No.
Project Name:
Setbacks Front Back: Right Side:° Left Side:
DETAILED-.DESCRIPTW
ION OF ORK:
-CONSTRUCTION INFORMATION
Additional work to be nerformed under t is permit—check all thal appy:
HVAC ((--��Gas Tank []Gas Piping OGenerator
Shuttersn Widows/Doors
Electric L_I Plumbing Sprinklers r ' L_J Roof
Total-Sq.Ft of Construction: �_ { S .Ft.of First Floor:
--fir r� � - 1
Cost of Construction:$_ ��Od Utilities:Sewer Septic Building Height.
-DWISIERAESSIEE Ct NTRACTOR: . j
Name Name:
Address: ca Company: r C
City: ! ' -- State: Address: t� j�
Zip Code: 3���� _ Fax:- C.iLy: F f i�, ' State: l
PhoneNo. � ��2L(c'r � Zip Code: 'eq 5,0)— Fax: 7�7 ''V&(v-r-ff5p
E-Mail: Phone No.
Fill in fee simple Title Holder on next page[If different E-Mail: C;ft
from the Owner listed above) State or Coun icense:
If value of construction is$2SOO or more,a RECORDER Notice of Commencement is required.'