HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
i
Date: Lp• �� �� Per Number:
RE CIE -
Building
Building Permit Application
11
Planning and Development5ervices 1"K1 2 3 �11
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: vj 1 f
PR.O.IrOSfD_INPR:OENIIiENT L®CATLON;
Address: S[ 2 t �W N N \J 1'sv_CE ice(
Legal Description: E5'tct C.C.O
Property Tax ID #:
Site Plan Name: _
Project Name:
Setbacks Front
1✓XI
L? ? -
Back:
0-7i
Right Side;
Residential
-54,)8 2 --
Left
Left Side:
Lot No._
Block No.
t ac Vro ,
Additional worK to be pertormed under this permit– checK all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator .i _ Roof Pitch
Total Sq. Ft of Construction:: Sq. Ft. of First, Floor:
Cost of Construction: $ Oc �9 Utilities: —Sewer _ Septic � Building Height:
ti
OWNER/LE=�SS�E:
CONTRA OR:
'
Name SQq LM T1a1c46»OC
Address: 151 Z U rJ N
City: F9` T- State:Tf
Zip Code: 3t I Fax:
Phone No. 9 ► (?L d
Name:
Company:
Address:
City:
Zip Code:
Phone No
E -Mail
State or ounty License
State:
Fax:
E -Mail: < M 6YYLL$ I Q`( CuN
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Com"ncement is requ
Sll'PPLEMiENTAL CONS�TRIJCTIQ.N LI?EN LAiW ItNF®RIMAiIO: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
commencing work or recording our Notice of Commencement.
Type of Identification
Produced
Produced
Commissio o. (Seal)
Sign ture of Owner/ Lessee/Contractor as Agent
Signature of Contractor/License Holder
FRONT
ZONING
SUPERVISOR
STATE OF FLORIDA -
M
STATE OF -FLORIDA
SEA TURTLE
MANGROVE
COUNTY OF
'
COUNTY OF
REVIEW
REVIEW
o s��
REVIEW
REVIEW
REVIEW
The rgoing Inst ent was acknowledged before & �� i
The forgoing instrument was acknowledged before me
this day of 20�by 6 �_ �
this day of , 20_ by
G �-tt 9
6 NOj
� N
DATE
(Name f person acknowledging)
(Name of person acknowledging)
COMPLETED
(Signature of N t ry Public- State of Florid
(Signature of Notary
ev. 7/2014
Public= State;of Florida )
Personally nown OR Produced Identificatior�
Personally Known OR Produced Identification
Type of Iden ' 'c tion
Type of Identification
Produced
Produced
Commissio o. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED