HomeMy WebLinkAboutBuilding Permit Application I .
i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED MM
Date: Permit Number:
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:
PRaPOSD INROVEMEIVT LOCATION a w F
Address: ��� 0 FAA- the I2 �C
Legal Description:
Property Tax ID#: C�4�oZ�1 F1(C) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:
DETA(l.ED DESCRIPTIO!QFC WORK4
._, � _� r . e r_z R_ . -. . �.
_ _
ATRUCTICIN INFORMATICi[ ��
Additional work to Be performed un er t IS permit—C eC all that apply:
echanical _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:$ b 6 c' Utilities: Sewer _Septic Building Height:
Name 401 01 M.e . A-iii O/'
Address: !� O l s w " i(y�.i i t "i ic. i n� ` ' Company:'':' ;.., �rti-t �' `z_ c 9
City:rpm_ State:F—L- Address:
Zip Code: 3�i ig 5 3 Fax: City: 190r-T S"� L-c�L.,'e Stater
Phone No. Zip Code: 3!V Fax:
E-Mail: Phone No .46 1—y Z – i1J"�
Fill in fee simple Title Holder on next page(if different E-Mail �'.S'� ,n
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is"required. \
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.-
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
commencingwo or rec din our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Con actor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF -1z:ZA
The forgoing instrument was acknowledged before me The for oing ins tru nt was acknowledged before me
this t day of { —,2o nby this VAday of 201a by
(Name of person acknowledging) (Name of person acknowledging)
( ' ture of Notary Public-State of lorida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification A TV pe of Identification
Produced LASHAHNA IN94* oduced
:+ .�•: otary Public-State of Fiprl s��P�e�,, AHNA.INGRAiV!
.o; Notary Pub' ate of Florida
Commission No. N `�; Expires Dec 20,20 0mmissio.n_No. ' Dec 20,2018
°� Commission#FF 177249 y Comm: ��
q;�; •`� %° Po;= Commission#FF 177249
Bonded through National Notary Ass ,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
OMPLETED