HomeMy WebLinkAboutBuilding Permit Application ii
All APPLICABLE IN O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u
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ate: �S Permit Number: / �a
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Building Permit Application
Planning and Development Services it
Building and Code Regulation Division ,i
2300;Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
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PROPOSED INRR.OVEMENT IQCATIOIU
Address: x Y L rC ' L II
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Legal Description:
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Property Tax ID#:�zl ��dc�`����� Lot No.
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Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPI'!ON aE WORK
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CC3NSTRl1CTION INFORMATION
Additional work to be pertormed under this permit-c ec all that appy: „
_Mechanical _Gas Tank _Gas Piping _Shutters it _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 113C Utilities: —Sewer _Septic Building Height:
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OWNER/LESSEE CONTRACTOR,>
Nam Z M tn-ieA Q Name: !�
Address: Company: it
Stater Address: 4
Zip Code: R, Fax: City: State:
Phone No.f77Z ) C�N�J `703 Zip Code: l Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail II
from the Owner listed above) Sta or County License,
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If value of construction is 2500 or more,a RECORDED Notice of Ccfrhmencement is required,.!
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SIt,PPLEIUIENTAI CONSTRUCTIQN i lEN'LAW tNFORNIATtaN
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.
Signature of Owner/Lessee/ ontractor as Agent for Owner Signature of Contractor/License Holder
STATE.OF FLORIDA r STATE OF FLORIDA
COUNTY OF COUNTY OF
The ping instrunt w s acknowled efore me The forgoing instrument was acknowledged before me
this day of 2by this day of .20_ by
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary ublic-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR P o d'Identification Personally Known OR Produced Identification
Type of Identificati Type of Identification
Produced N3 - - Produced
'ift public-Sl FF 23413 ��
o . ,N6otaY V•2pj51(Seal) Commission No. (Seal)
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REVI. �S T' T FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014