HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �Tl �� Permit Number:
#_ � � £� RECEP.'7D-AUG,04 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
--2300'VirginiaAvenue;'Fort-PierceFC3.4982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial. Residential
PERMIT APPLICATION FOR:
Address: 92P3
Legal Description:
Property Tax ID#: �' y�� ��C�a.. X04 Lot No.
Site Plan Name:- Block No.
Project Name:
Setbacks Front Back: Right Side: Left-Side:
SEW
J �
IN 11111111 5
Additional worK to be pertormed under this permit–c ec a '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:$ �— Utilities: _Sewer _Septic Building Height:
Name GGA Name:
Addr Company:
city., Stat ly 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.
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 AWNER: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.
ignature of Owner/Lessee/Colitractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO�DA STATE OF FLORIDA
COUNTY OF A% 1. COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�day of q ,20 by this day of ,20_ by
(Name of person ack owledging) (Name of person acknowledging)
(Signature of Notary PubW--State 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
Produced Produced
Commission No. DL1m fOolsTnNsozs Commission No. (Seal)
• My commitsioN
mbar 16,?R'-
Dece
Bonded7hNNotary,..:.:., .
REVIEWS FR UPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
CO REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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