HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349132
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of tine
PR( 0(T-%fif1 tMPR0V- FK1FNT L CATION -
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Address: 0
Legal Description:
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Property Tax ID #: q o i ` (j — 0(go -5
Lot No_
Site Plan Name: lJ(),V NFKS EAJ _ Block No.
Project Name: b i� g19PJ
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QFWOW
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CONSTRUCTION INEOWATION
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11HVAC Gas Tank E]Gas Piping
Electric El Plumbing Sprinklers
Total Sq. Ft of Construction:
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Cost of Construction: $ J,(30
L.J Shutters
CGenerator
SFt. of First Floor:
Utilities T] Sewer [ Septic
Windows/Doors
1-1 Roof
Building Height.
OWNER/LESSEE; .
eONTRACT R
Name • U1t16EP.sg
Address: « {)1?,
City:!�o d -S P, rtUC SB c a state -IV
Zip Code: JI7J-q Fax.
Name: AUP,
Compar+y: /1920AA1-6
Address: 1193 6 ° l0-+�i
City: Q�! Lor—le
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Slate: 1=L
Phone No. -�l I-a6a-a179
Zip Code; 3 `
Fax:
E -Mail:
Fill in fee simple Title Holder on next page ( if different
Phone No. 77&-3'70--5-75:5
E -Mail: DC%r"f iCq Q, 'J6-7-
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State or County License:
iEC 00C 307 Q-
fromthe Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Not APP
Name: _
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:.
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name;
Address:
City, State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
r1ty
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
swhich tructure. conflict with
your Home Owners Assrs Association
iation a d review your deed laws or for any restrictts ions whichma rict oapply-
In
prohibit such
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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. Lucle 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 th first insp ion. If you intend to obtain financing, consu with lender ar an attorney before
commed�ne wor yr recording your Notice of Commencement.
of O*er/ Agent/ Lessee
STATE OF FiE
COUNTY OF.
The for sing instrument a acknowledged before me
this day of 20j� by
G
(Name of person acknowle Ing )
(Signature of Notary Public- State 6fFlorida)
Personally Known /A-. OR Produced identification
Type of Identification Produced
Signature of Con ctorf license Holder
STATE OFF IDA
COUNTY OF
The forgoing instrument s acknowledged before me
this L clay of 20 by
(dame of person acknowiedgin
(Signature of Notary Public- state of Ffbrida J
Personally Known OR Produced identification
Type of Identification Produced �g111i1111t1111
Commission No. ��` ": •; �>r Commission No.
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REVIEWS I FRONT
COUNTER
DATE
COMPLETED
PIANS I VEGETATION
REVIEW REVIEW
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