HomeMy WebLinkAboutBuilding Permit Application i
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`All APPLICAB E INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Q �� � 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 Re' idential
PERMIT APPLICATION FOR:
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RtJPO5INPf20�tE�ENT �OCATi(JN ,
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Address: 0 AJ 410*Lf
Legal Description: I
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Property Tax ID#: dqpS � 0 3 �d Co 4-, 000 L Lot No.'
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CON�'RUCTONjINFORMATION
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Additionalworkto a per orme under this permit–c ec a that apply:
_Mechanical Gas Tank —Gas Piping _Shutte _Windows/Doors
Electric Plumbing Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ DD Utilities: i Sewer _I Septic Building Height:
CONTRA R
Name oaIl AIZ2 l' Sa'n Name: . e
Address: W t7U 61er j � � f
�^ � '�- Company: ��� i�t'v�,;,. �of�/,'
City: VI. Y C --�
State:fL Address,61116,
Zip Code: Fax: City:
Phone No. State:
Zip Code: J�.�Cj' ��
E-Mail: Fax.
Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) d
unty
tf va/ue of canstru �
ctioState or Co
n is 2500 or tore,�RECORpEp Not%Ce OfCO/11
mencememIs
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SUPPLEMENTAL CONSTRUCTIC}N LIEN LAW INQRIVIATIC)N
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r. . F �:R pp MORTGAGE COMPANY:
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DESIGNER/ENGINEER:, Not Applicable PANY: _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/LesseJ4CQntkAtor as Agent for Owner, Signature of Contractor/License Ho
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ���l� L-e__ COUNTY OF t �—
The forgoing instrumeat was acknowledged before me The forgoing instrument wa acknowledge afore me
this�C'day of Or y this lay of 20 by
Name of person making statement. Name of person making statem nt.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatic —� ( TypeIdentifio
—cat rrj'1�
Produced I .`� Produced �--�
(Signature of Notar I( �f1i��lg3 !iof,I�ni¢#aio0 „job,, (Signature of Notary s bki�cR uog ,o�aiO�16Y,
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0tLVZZ dW#uo!ss!w�ni) -• ;•_ k Commission No. 5102 W uo!ss!w heal)= -
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Commission No. a ^
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J� SUPERVISOR PLANS VEGETATION 2 SEA TURTLE MANGROVE
FRONT ZONING REVIEW REVIEW REVIEW REVIEW REVIEW
REVIEWS COUNTER REVIEW
RECEIVES
DATE
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