HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Permit Number.
Building Permit Application
Nou\\"�ae,
Commercial Residential
PERMIT APPLICATION FOR:
PROP INPROVEMENT 1-02 JON:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: V!1 *
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
_Mechanical _Gas Tank _Gas Piping
_ Electric _ Plumbing —Sprinklers
Total Sq. Ft of Construction: f =Ql7
Cost of Construction: $ZTW
NER/
a
_Shutters _ Windows/Doors
_Generator Roof 3 11A1 12 -,Pitch
Sq. Ft. of First Floor:
r
Utilities: _Sewer _Septic Building Height:_
Name iS v -
Address: ZOc�--
City kwi PLP.rLei Stater
Zip Code:,54lgS7— Fax:
Phone No. 77Z^ 4i1 '/�Z3S
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company: f
City: %J State:_r_�—
Zip Code: 3L Fax: 772'r�As-43q
Phone No77Z-77
E-MallAt . Ae'
State or Coupty Licgrse l'1l_0s%-SI In
If value of construction Is 2500 or more, a RECORDED Notice of Commencement is
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: -k- Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: eN::-Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Applicable
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 Count
yy 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 Assocfation rules, bylaws or and rcfvenants 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, 1 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
commimcing work or recording your Notice of Commencement. ,
as Agent for Owner Signature
Holder
STATE OF FLORID � ' STATE OF COUNTY F ORIO/,Zi-) LUL��
COUNTY OF .�T'
The for oing Inst��m�e�n�t was acknowledg before me
this day ofJL�f�— ZO by
4)1&U, c,4,/
Name of on making statement.
Personally Known OR Produced Identification
Type of Identification
Produced
R�
f%knatunillif Notary Publ of 1Ton a JAIME ORTIZ
6
Notary ►yp80.. State of FIOrI
Commission No. W004". Eyhas Jun 1 20
ad CommWW N FF 111185
REVIEWS I FRONTZONING
COUNTER REVIEW
RECEIVED
Ing instr nt was acknowledgg,e before me
day of _ 2d Dby
Name of personAaking statement.
Personally Known
Type of Identification
M
SUPERVISOR I PLANS VEGETATION
REVIEW REVIEW REVIEW
OR Produced Identification
$106 of Flmiaa
"Jun 1.2016
0 FF 111185
SEATURTLE. I MANGROVE
REVIEW, REVIEW