HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Ste- (CL 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 Y
PERMIT APPLICATION FOR:
Address:
Legal Description: W -
2�
Property Tax ID #: So Z -- (0 C) Z i - 000 / g Lot No. `Z -S
Site Plan Name: Block No.
Project Name:"��
Setbacks Front Back: Right Side: Left Side:
_Mechanical _ Gas Tank _ Gas Piping
N' Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
GO
Cost of Construction: $ L/O0
Shutters
I —Windows/Doors
Generator _ Roof Pitch
Sq. Ft. of First Floor:
1
Utilities: —Sewer _Septic , Building Height:
Name 'F ; d11 (��r ►1-��jY1C�C7�
Address: 9 l`7 a2-J<-S6--,-
City:
S 2-J<s6-,-City: State: �L
Zip Code: 3q7,Y!2 Fax:
Phone No.C-7 -7 2- -3 / - ? 2.1 Z
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: TC9•►�sza- �(ec�rr/�
Address: (C�i fv `ZC'"rS;✓J".
City: \/ e L'v gezc,k- State: �L
Zip Code: X29 fec9 Fax:
Phone No -7
E -Mail
State or -County License ' EC
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFO
. MATION:
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
commpnring work or rprordine vour Notice of Commencement.
6``2 i�����u.•yl�--- l `j 2cg/ P�
`f i� �Zw/Y1 �✓�-= :�l i— 2U P
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA '
�G
COUNTY OF 5�� _
COUNTY OF
The f ing instrum n was ack owledg efore me
this day 20 by
The fQ ing instru e t wastnowled,611H)fore me
this of y
of
—1clay
(Name of person ackno
ledging)
(Name of person acknowlecl
(Signature of N ry Public- State of Florida
(Signature of Not ry ublic- State of Florida )
Personally Know.dared d do ti
Personally Known OR Produced Identification
Type of Identi ani t1P�a,,, ANGELA M HUFF
Type of Identification
Produced 9, `�;�ojryZublic - State of Florida
Produced
•.f P� b •_ Commission #. FF 234730
Expire
a � I7,2019
No. rnNaryAssn.
yP'a.MyComm.
Commissiri_X K
ANGELA M HUFCommission
Notary Public
; • - - State of Florida
Com mission
,, o i F;�•• P y om
.Expires May 27, 20
9
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