HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' Z��� Permit Number:
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Building Permit Application
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 a3AI9D1d —I
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INPRCM
Address: S h
Legal Description:
Property Tax ID#: //Z�— TUB �3C�d^ Q 00'�/r Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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ORMATIM
Additional work to Be pertormed under this permit—check all that 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: $ 500 Utilities: —Sewer —Septic Building Height:
OWNE { ..
Name 77r� Y/5 fC6 Name:
Address: 2CfOl e4 "2f S� Company:
City: J! #V/C << State:r—C Address:
Zip Code: 33 YZ 6 Fax: City: State:
Phone No. / ' ��� ���� Zip Code: Fax:
E-Mail: ( Y &c1 t&,M-✓I a5gr_ Ph ne No
Fill in fee simple Title Holder on next page ( if different ai
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
PLEMEALC ,. 1,
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 thepermit 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-opfer—or-djng your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �V Lue COUNTY OF
The for oing instru Vent was acknowledge before me The f r oing instr ment was acknowledged before me
this day of d,20 by this day of 20Z by
IScay'ie rar
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification t/ Personally Known OR Produced Identification
Type of Iden 'fic tion Type of Identification
Produced Produced tL D
M(�' Oltr -4/,O-A 0 AA
v
(Signature of Notary NIELSEN (Signature of Notary Publi ¢IoriMPEN S. NIELSEN
'�•%, '_ Commission Commission # FF 115637 = son# FF 115637
Commission No. My Co(6e8#yion Expires Commission No. ;E�„ My4ff'ssion Expires
June 12. 2018 1 12, 2018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17