HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a a1 ,11 Permit Nu;Resi
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Planning and Development Services "tt'nBuilding and Code Regulation Division ���9 ®@p�2300 Virginia Avenue,Fort Pierce FL 34982 C FL>tPhone: (772.)462-1553 Fax: (772)462-1578 Commercial e
PERMIT APPLICATION FOR: e�
PROPOSED IN,RROUEM�ENT LOCATION:
Address: !1 o I
Legal Description:
Property Tax ID.#: y y�,d �- a add- a�a d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:
DETALLED DE�SCRIPTtON OF WORK:
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CONSTRUCTIO�I IN�FOR�MATION:
Additional work to be pertormed under this permit—check all tat appy:
_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:.$ 02 Utilities: —Sewer _Septic Building Height:
OWNERf LE=�S�S£E: CONTRACTOR:
Name ADO Name:
Address: Cro ceer" lrrt2 Company:
City: State:E—L- Address:
Zip Coder f Fax: City: State:
Phone No. /_ /�— ��G-2 37 Zip Code: Fax:
E-Mail: i/IsIf7 ,fCG , lGrr► b ��1 %�•�'�+ Phone No-
Fill
o Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S PPLEMEN MCI r CTI�N LIaN LAW FORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address:, %} ` -- j Address:
City t77,
State: City: State:
Zip: Phone Zip: Phone:
Y'ii'• i
FEE SIMPLE WfLE HOLDER:., .. ,:. `. Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: t:. 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
comme ncing work or recording our Notice of Commencement.
Signatu a of wner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA.
COUNTY OF S*. �-y C �e COUNTY OF
The forgoing instrumentwas acknowledged before me The forgoing instrument was acknowledged before me
this'al day of QM. 1_ 2011 by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced V Produced
(Signature of Notary bli.- pEpNNAMAR7.GIVcNr— (Signature of Notary Public-State of Florida)
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Commission No. �': sioN#
MFY�C� ewrnber is,2029 Commission.No. (Seal)
^o u No�7 Public Underwite'
Bonded Th '
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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