HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'i i
Date: Permit Number:.':
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Building Permit Application
Planning and Development Services ;I
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:
PRC7POS,ED I,NPR01/EMENT LOCATIt?N
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Address: )'7 17 d1c��._a_ I (D
Legal Description:
Property Tax ID#: Ra 000 - a ;Y Lot No.
Site Plan Name: ms, 4gjd-4-� �cnce_ �t,rm+ f Block No.
Prolett Name:'
Setbacks Front Back: Right Side: Left Side: I
DETAILED DESCRIPTION;OF 1111ORK. ti
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.CONSTRUCTION IN-FORMATIN e e „
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Acid Mona I work to&be pertormed under this permit-check all tat 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: i
Cost of Construction: $ X50' Utilities: —Sewer Septic Building Height:
OWNER/LESSEE �,CONTRACTOR
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Name ►' tC,&dtf 37)tytgme-nY Name: 1�'1 fchcwL; �►F ne�4G�
'i cldress: h1fu 4ntZ 0I'✓1. Pr,.f_ Company: 60nST
City: State:,FL Address: yd !,c9r^P S0"n p ^�c `f`Yri f2-
Zip Code: 3 V'L y� Fax Z lloS -n7_3 City. Stater
Phone No. 7 70, 7797 Zip Code: `�tiSyS� Fax: 7`7Z 7W_�
E-Mail: Phone No79-1
Fill in fee simple Title Holder on next page(if different E-MailP--s-A-,? eo✓rS4- i h L . 6) a-0
from the Owner listed above) State or County License ;-qoo Bbl_ I
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CSN,STRUCTlONI^ N LAWIN.,.,
_/ENGINEER: Not Applicable DESIGNER MORTGAGE COMPANY: - N',;
of 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 wner/Lessee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF` SAVLI�
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L day of 20 by this �$ day of fl)w e. 2013 by
(Name of person acknowledging) U (Name of person acknowledging)
lsig6ature of Notary Public-State of Florida) (Signature o ary Public-State of Flo&a)
Personally Known OR Produced Identification Personally Known C!R,P.6d.uced IdentificatibhNGRAM
Type of Identification Type of Identification _� ` �!otary,,LLiic-State of Florida
Produced Produced °` * My Comm.expires Dec 20,20 i B
c i AHi�A tNGRA .,s o���0
�- commission#FF 177249
Commission No. ,,,, (Seal)3tate of Florida Commission No. Bonder}t r h Nations{Notary Assn.
N!Otary QG F% iteS D2C 2�.HC1g -
t comm. �n�#fF 177249
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