HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPQWt0N TO BE ACCEPTED
Date: 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 Residential
PERMIT APPLICATION FOR:
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Address: y ( I a 4-$I � I I I' .I
Legal Description: ! ? 1
Property Tax ID#: �� ( " S o ( ( � 2 a _ 6 i i', ! Lot No.
Site Plan Name: II Block No. .
Project Name: i 11
Setbacks Front Back: Right Side: Left Side, li,MM
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rtional work to be performed under this permit-check all tat apply: i I`
Mechanical _Gas Tank _Gas Piping Shutters !' Windows/Doors
E;lectrc `_I Plumbing _Sprinklers ': .rt Generator �' ! Roof
T6t6l Sq. Ft of 'Construction: Sq. Ft.Lof First Floor:
Cost of'Construction:$ 7-160 6 Utilities: Sewer. Septic Building Height:
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Name �'1 cl r ��-,�uJ L 1,1 O u- p Name: C
Address: Company: \N 111�f ,l\Q: 2 ' � nL
City: d` S* r V 411-<- State: R_ Address: )S()!
SZ Fax: Cit F 4- I1C C i l; I State: FL
Zip Code: �-1 y:
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Phone No. Zip Code: '_JG 4i 7 .I;, Fax-
E-Mail. Phone No. 7721 - 4
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Fill in fee simple Title Holder on next page(if different E-Mail: Vr�"'o COM
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from the Owner listed above) State or County License:;:14
If value of construction is 2500 or more,a RECORDED Notice.of Commencement is re"
uired.
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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.
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/Agen Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 6a;_ .4, LLAc COUNTY OF S4 4- L_
The forgoing instrument was acknowledged,be The forgoing instrument was acknowledged bef
this jR day of n e e,w�b4-r- ,2Q1`7 by this day of O2.ce.m log r- 120_LZ by m'
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(Name of person acknowledging) 0 3 � (Name of person acknowledging), OMLO
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(Signature of Nota Public-State of Florida) o� to (Signature of No Public-State of Florida)
Personally Known �OR Produced ldenti cat& a Personally Known ,_�OR Produced Identification
Type of Identification Produced Type of IdentificationProduced
Commission No. r F o,16 4o 3 (Seal) Commission No. T OqC'�(Q,i (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014
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