HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�' ��� 1 4� Permit Number:
Building Permit Application df
Planning and Development Services MA �+ 3 20��
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: To Select from dropbox, click arrow at the end of line
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Property Tax ID#: 13o�z Rgw - 0033 _ DOD--7 Lot No.
Site Plan Name: Block No.
Project Name:
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Name S�Lr�� � 1Dc% A.)_ T Name: A
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City:_ �S ) -�� Stated• Address: 'K 3 7 5, JlIV4S IJWY
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Zip Code:_ Coax: City: ri- Yteme- State:
Phone No. 1 3`lg 0 3 q) Zip Code: 3qi l,5' Fax:
E-Mail: Phone No. -1-2 a� Y0 q�-D l
Fill in fee simple Title Holder on next page(if different E-Mail: e-ayi n f, lobl's4libnorf- t-C,- 60tyl
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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
commencinR work or recordinia vour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent Signature of Contractor/License Holder
STATE OF FLORIDA J,�i�.'*•hoN_
k' STATE OF FLORIDA• ;* �s
COUNTY OF I/ �� p��•• COUNTY OF
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The for oing instrument was acknowledged fne< The for oing instrument was acknowledged before :E
this�day of f��fi 20 by 2 ' thisday of H� 20� by C-1)S.
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Name of person making statement _ Name of person making statement
Personally Known OR Produced Identifi t�r�' = Personally Known OR Produced Identificat
Type of Identificai n VQ Type of Identi
Produced "N Produced
(Signature of No ry Public-State-of Floridy)- (Signature of No Public-State of Florida
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17