HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Applic
Commercial
Address: `d 11 %� ('M2,f Z- /N K L/ IVO- /fit'
Legal Description:
Property Tax lD #::r� ay3y� d�
Site Plan Name:( -
Project Name:
Setbacks Front Back:
S Ocao� cl
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Right Side:
Left Side:
Residential
Lot No.
Block No.
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Name' A in M Y A i2C aot�'
Address: ori I TV**t4.d4 eg kLI1116
City: State:Address:
Zip Code: �, c �� Fax:
Phone No. 57 % 7,"y
Name:
Company: STy f`rg,
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CaN4STRiJCTIQN INFOR+i1lIATION:
City:
Zip Code: ..S'���//(//S
Phone No
Additional work to be pertormed under this permit -check all that appy:
State:hL
Fax:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator
_ Roof Pitch
Total Sq. Ft of Construction: !FAL Sq. Ft. of First Floor: i-
Cost of Construction: $ /9aO V Utilities: —Sewer _Sept, ic
Building Height
SMN"E: IR/LE�SSEE:
C®NTRA
QR:
Name' A in M Y A i2C aot�'
Address: ori I TV**t4.d4 eg kLI1116
City: State:Address:
Zip Code: �, c �� Fax:
Phone No. 57 % 7,"y
Name:
Company: STy f`rg,
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City:
Zip Code: ..S'���//(//S
Phone No
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State:hL
Fax:
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail IT(i
State or County License
Ci� S3
lcCC 515& 73Hr
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: K'.L� i1�'�/) i��� Name: (�
Address: Address:
City: State: City: State:
Zip: Phone S'� ( ZS7,( f%F2 . Zip: Phone:
FEE SIMPLE TITLE HO ER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMP/,NY: j Not Applicable
Name: (�
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Aoolication is herebv 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 toanother 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
comm,enci,ng work or,recording your Notice of Commencement. A
/�W
"ofOwner/
Sig t e Contractor/License Holder
Si ature Lessee/Contractor as Agent for Owner
STATE OF FLORIDA `
STATE OF FLORIDA
COUNTY OF
COUNTY OF 'S U -C
The f ing instru `ent w s acknowledg efore me
this Iday of 20�`�y
The oing instr ment as acknowledge before me
this day of 20�by
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S: SAU r -r Led.
(Name of person ac nowlidging )
(Name of person acknowledging)
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(Signature of No ry Public -State of Florida)
(Signature of N gary Public -State of Florida )
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Personally Known OR Pro u --Identification
Personally Known OR Produced Identification
Type of Identifica - —��
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Notary Public - State of Florida
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