HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit i!17.
C• -
- - 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:
Address:.
Legal Description:
Property Tax ID#: 4401 _ 6006-060 a Lot No.
Site Plan Name: Block No. .
Project Name:
Setbacks Front Back: Right Side: Left Side:
�2r��cP L00 *,no 2-`to vel -fir- poo I .,
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Additional work to be performed under this permit-check all-that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/,Doors
Electric _Plumbing _Sprinklers ` Generator _Roof
Total Sq. Ft of Construction: Sq.-_k.-ofFirst Floor:
Cost of Construction: $ �v�� Utilities` Sewed _Septic Building Height:
Name l ►1ftl, V&'� r ,llnw ",:; Name:
Address- AF t �� -Company: thc-
u
City: v0pVt C :r,., "„;" tater Address: -35'04 r nS-4,..-
Zip Code: 33y99 ;FaXsJ = :' ```"x k City: State:-
Phone
taterPhone No. X72 `�Gt �Dja� : k' Zip Code: lie,L17 Fax:
E-Mail: Phone No. LkG—aS-
Fill in fee simple Title Holder on next page (if different E-Mail: �.l�u�L t►,L 6ef, CCU-
from the Owner listed above) State or'County License: EC 13(J4 5S-n
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.
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
commencingwork or recording our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA «••. STATE OF FLORIDA
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COUNTY OF Sa:�-�' t-�^c J2 :°'.. �."fir:. COUNTY OF91
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The forgoing instrument was acknowledged before '••, Theforgoing instrument was acknowledged,before me
this day of R�gctiS Y 20_!J by X O this l. day of 201 by
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(Name of person acknowledging) d Q cn (Name of person acknowledging)
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IV Signature of Notary Public-State of Florida) o $ ignature of Notary Publi -Stat f Florida)
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Personally Known OR Produced Identification Personally Known OR Produced Identification .
Type of Identification Produced Type of Identification Produced
Commission No. FS OgbL Oo (Seal) Commission No. ��e
�pSHA�N State of Flonda
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REVIEWS FRONT ZONING SUPERVISOR PLANS VnP{TL .; MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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