HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: PermitNumber:,
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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, PC)SEd".I`I�PRfJUEMEIT,l:O_CAT,
I
- Address: i0s �
Legal Description:
ID
mProperty Tax ID#: OK — V �(J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED QESCRII?TION CSF WORK. ;, r
�Yl 1 CL r
'bI �Gr p x
GC)CJSTftUCTION INFaR1UTATiON
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Additional work tobe pertormed under this permit–check all that apply:
_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: $ 00 , Utilities: Sewer _Septic Building Height:
01IVNE0jLESSEE;
Name ^ Y Name:
Address: J Company:
City: YpY4 State: Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
�,;, z��,.r<:t,-wp�� �:�, "��A>•;. p3 �r„`�^,gk sn �r .��:.«re OM1 �^l�;e"%�" .f -.4 a��'iii�i. �». J€"x�..�',.T` e rvi o-�cE,"Ix•,ti3
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 certifythat no work or installation has commenced prior to the issuance of a permit.
-St:Lucie County-makes-no rep resentation-that.is-,granting a-r,ermit will-authorize the permit holder to build the subject structure
whichis 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 recording our Notice of Wmmencement.
t`
Sig tore o Owner/L ssee/Contractor as gent for?vfnbr Signature of Contractor/License Holder
STATE OF FLOSTATE OF FLORIDA
COUNTY OF
I COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_0by .. this day of 20_ by
i
(Name f rsan ackno {edging)- - - - Na'ine-of-person-acknowledging.-)
- � -
(Si a ure of Notary Public-5fAte 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
rKrod ced RppA Produced
o IIQ. %D• 'L� •b :'::r�.r:: 54 Fa1;4A1��' 01 Fla;ltla
< E jtate t
mission No. t' �10 aeC�fJub XpVp's pe 1Tl21e9 Commission No. . (Seal)
(;om�'`sslot+*k FFIDlolaty NS110
REVIEWS FRONTlag
PERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTEK,\" REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7 4