HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number: 002 0 3v
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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 Residentialt
PERMIT APPLICATION FOR:
PRO;P.OSED INPROVEMENT LOCATION:.
Address: .3 Ltq
Legal Description: L54-2- aA V-)boaL 1`7 Pbq.. '
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Property Tax ID#: 1300 10002A%YDL2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: RightSide: Left Side:
DETALLED DESCRIPTION O.F.WORK
CONSTRUCTION INFORMATION
Additional work to be pertormed under this permit-check all that app y:
_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:
OWNER/LESSEE:" CONTRACTOR:
Name �f'Y q LX C :ea.-._ , C
's: A CA 0.71 An"Y: -
?§ City:+ 13L& ri. Stateis
Zip1Code:34q.�i- -slity: '= f":,;.' State
Phone No. Zip Code: I-ax
E-Mail: Phone No L9 ez
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or CountyVi ense I KV eo
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPI:EMENTAL C.QNSTRl1CT{ON USN LAVI/ IN ORMATION
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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.
Signatu a of Owner/Lessee/Contractor as Agent for Owner Signature f Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF o COUNTY OF Q
The forgoing instrument was acknowledged before.me The for oing instr ment was acknowledged before me
this�day of 20D by this r��� day of 2011 by
(Name of rson acknowledging) (Name of pe on acknowledging)
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(Signature of Notary Public-State f Florida) (Signature of Notary Public-State 8f Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
L SH HNA I e"" S
Commission No. � `°��% Notary gm1)-State tliilNld✓A Commission No. A�n""�' �. �LASR HNA INGilAlwl
• Of C4 l9fn.Expires Dec 24,201/ � �+y Notary Public-State of Florida
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REVIEWS FR SUPER IS PLANS VEGETATIO �l 9�AiII
COUNTER REVIEW REVIEW REVIEW REVIEW fhru �REV1 ,
DATE
RECEIVED
DATE
COMPLETED
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