HomeMy WebLinkAboutBuilding Permit Application ' I
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All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:. ' ti 1y'a
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 ReS',I'Idential
PERMIT APPLICATION FOR:
R } 5f® FN FRC�1/E�Mqf.T1 1.0 0 m ANT1 h1.
Address: 847JaZ. 4ZIJ, CSW� �� j 5'Y
Legal Description:
Property Tax ID#: tr�, ^1 ' 1 � � '1 Lot No.
Site Plan Name: I till^i Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be pertormed under this permit check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters ij k _Windows/Doors
_Electric Plumbing _Sprinklers _Generator ''I Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: it
Cost of Construction:$ Utilities: —.Sewer —Septic E'i1: Building Height:
�toffi.
Name G. Name:
Address: � 1—-w4:�Sw-A-V Company: k l
City: PAT7 ,17n L.VC.j,&- State:JEL Address: I
Zip Code: Fax: City: 1 State:
Phone N" S7/—.-7?i f-- Cqljn Zip Code: i' y Fax:
E-Mail: Sa®yZ Phone No
Fill in fee simple Title Holder on next page(if different E-Mail EL;
from the Owner listed above) State or County License {
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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.
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'aby a pplica'ble-Home Owners.Association-rules,;,bco
ylaws or and- venants'that.may.�estrict+,Or"prohibit such
structure. Please-corisult with your Home Owners Association and review your deed for any restrictibns 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.
Sig6e _ r L ee/ o'ntrtfctor as Agent for Owner Signature of Contractgr/License Holder
j.
STATE OF FLORIDA n STATE OF FLORIDA
COUNTY OF , '" ;�' ? COUNTY OF'
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-�—day of 20n by this day of 20_ by
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(Name of person ack wledging) (Name of person acknowledging)
n
4(Siature of Notary Public- ate of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. -. a--;; (Seal)_;?
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION,,,,, SEA TURTLE 1 MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW'' 'REVIEW -. ~°REVIEW
DATE
RECEIVED
DATE
COMPLETED
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