HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
- Building Permit Appl,icati;on
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
3
PERMIT APPLICATION FOR:
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PREP' S`ED f . PR®111: IE T LOCAT�QN
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Address: SXU Cunch P\(A.C�L �� D l9nC0
Legal Description:
Property Tax ID#: � �3•- c ' OaBB• ��� -! I' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side".
Wil'l _.
D' AfLED DESS IPTION Q W®RKWIN
CO STR.IJWA
TON fNF®RIVIATf'®N.:
Itional wor to be pe orme un er 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: -I Sq. Ft. of First Floor: i
Cost of Construction:$ I , ;^71 Utilities: _Sewer _Septic { Building Height:
3 I ;
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OWNEf2 LE�SSE'� +�ONTR 4h
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;Name -S p rnt S n� rnDn St Name:
;Address: qA P srilm t l�x.0 Company:-, l&Y, G0Y1 C/1R/1r
City: MState: Address:
Zip Code: a d Fax: City: State:
Phone No. - 0- C Zip Code: ;Fax: '
E-Mail:, 10mS ,CQlrAf-r4lVbca4 • yLk Phone No-11a !ao r''8 !coS e-► 1�a-age-�'�7�
Fill in fee simple Title Holder on next page(if different E-Mail Y'0 d agy S cb-; :W (cP &M
from the Owner listed above) State or County License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required:
SUPPLEMENTALCQNSTRhL1 TION LIEN LAW IN= ANTMARS
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 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/Les e/Contra or s Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _COUNTY OF
The forgoing instrum t was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this day of 20_ by
(N9_mfi of erson acknowledging) (Name of person acknowledging)
igna e o Notary Public-Stat of Florida ) (Signature of Notary Public-State of Florida )
Personally Known , 7d�BBloducetl�7c]e°nt(fi� ��� Personally Known OR Produced Identification
Type of Identification, ;'2aa .��=; Notary Public , bta e o Type of Identification
Produced =•. .•;My Comm.Expires Dec 20,2018 produced
ission 0 FF 177249
,,,,,,�� Bonded t rough National Nolary Assn.
Commission No. �.� eatj= Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014