HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
1111111111011
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 Oct frorn dropbox, click arrow at the end of line
PERMI_APPLICATION FOR: To Sel
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Address:
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Legal Description: Ir
Property
In
600
Property Tax ID#- Lot
Site Plan Name: At9,Mjd asa 4numaag, Block No.
ProJect Name: -- - Aaai -
Setbacks Front Back: Right Side: Left Side.,
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a work to bL]GasTank
rformed Under th)s-R—rm—, c eck all apply:
HVAC OGas Pip!ng Shutters F]Wlndows]Doors
Electric Plumbing
-]Sprinklers OGenerator Roof' Roof pitch
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Total Sq.Ft of construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
dame_&U-a,00 6st Name. V. (37V
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Address- &Qmcr"l Company: S
City: e(f-,r(f State: Addr SJ - -( ouqe-r
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ZIP Code:�,6Lf!2,51 Fax-.=-,3 4!0Q:g'?07 City: ! -/
—i State:&-
Phone Zip Code: -,z�yg!5-z Fax:-77e---3'-7iD—q?Z-7
E-Ma C 4 Phone No.
Fill In ie imple Title Holder on next page �if different E-Mail: OrD6zol)%, comomt
from the Owner listed above) State or&-n—tyLicense:
If value of construction Is$2500 or more,a REO IRDED Notice of Commencement is required..
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY; i. Not Applicable
Name: Name:
Address: Address:
City; State:_- _ City: State:
Zip: Phone Zip:_ Phone; 'I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: I Not Applicable
Name: Name:
Address: Address: a
City: City:
Zip: Phone. Zip: Phone: ' 11
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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 s ructure
which is In cotrflict with any applicable Home Owners Association rules,bylaws or and covenants that may r�e�trict 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-resideklal 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
eommencin ork orpecording your Notice of Commencement. ,
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Sign O er/Lessee/contractor as Agent for owner si contractor/Llcense Holder
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ST F FLORID�} , ` ►TE OF FLORIDAA
C NTY OF- �� T (.ice COUNTY ltiFT- Ur f'' _
.The forgoing Instrument was acknowledged before me The f oing instrument was acknowledged before me
this day ofyb6r 26 J2 by this day of_0X119er__L 1241n by
Name of person making statement Name of person making statement
Personally Known yr OR Produced Identification Personally Known�_tiR,Produced identification
Type of Identification Type of Identification'
Produced produced
CRAIG A.IBRO 98MAN CRAIo A.QRS MAN
*r M W COMMISSION 9 FFSM02 ', •i MY COMMMOMN 0 F#OMW
i 1 ; 20
(signature of Notary Public-State, R gnatu a of Notary Public-State
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Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZbNINC SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW { REVIEW REVIEW
DATE j
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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