HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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 Residential
PERMIT APPLICATION FOR: ��aD
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Address: Z» /♦ ' ` .� Legal Description: alite Y1 l��,t♦t Sr k. Z� L& zZ kZ-s
Property Tax ID#: 30A0 &6—Q1-7-7`-n6Q�-` Lot No.Z2-�-Z�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed under tispermit-check all that appy:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_Electric _Plumbing _Sprinklers _Generator 'Roof Sfu+Mach
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
♦
Cost of Construction: $ ( 0j 66>0 Utilities: —Sewer _Septic Building Height:1�t
Name r Namez.3.�
Address: d' Company .S
city.C State:
Zip Code:3A0.0Z Fax: C't" nu state:
PhoneNo. �i %moi -�dy�3 Zip Code:3 Fax-3311�3
E-Mail: Phone No-77Z- Ms5 s �6
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or Cou ty License 3l
If value of construction is 2500 or more, a RECORDED Notice of Commencement is r quired.
DESIGNER/ENGINEER: of Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: Stater
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: 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.
1 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
comm nein work or recordin our Notice of Commencement.
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Signat re of Owner/ Lessee/Contractor as Agent for Owner
UL=�_
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �La�
COUNTY OF —�1�
The for oin instr ment was acknowled before me
this day of , 20 by
The for oin ins nt was acknowledge before me
thi =' 20f by
j
LO OAA I M..g 1 ajh L�
Name of lopffion making statement.
_•
jd�ay�of
Name of persong statement.
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
natur (Notary Pub] ;qf Flor1 a JAIME ORTi2
1.° Notary Stele o! Florid
Commission No. ' • M)%*&A, axwes Jun 1 201
CM11nMei1011 • FF 111485
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i nature o otary Pu li, , "'qff orida MME ORT1.
• • Public - S18411 of Fiorioa
ommission No. a�� Jun 1. 2oIa
noa C`-""""'"FF 111485
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
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