HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:r3 "{8 Permit Number:
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:
'FROPOSED INPROVEMENT CATION_:
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Address: �� B i IL
e/Y.� Z�
TE
Legal Description: S `u
Property Tax ID #: Bio -' S �i)�i��" ��-z- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
19WED _
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Additional work to be pertormed under t is permit — crieck all that appy:
_Mechanical _Gas Tank _Gas Piping _ShuttersWindows/Doors
Electric _ Plumbing _ Sprinklers _ Generator `! Roof J!'i 17 Pitch
Total Sq. Ft of Construction: 14040 Sq. Ft. of First Floor:
Cost of Construction:$ s.040,,gg Utilities: _Sewer _Septic Building Height:
Name Name: Gtf
`
Address: ` l CL✓� Company: l \
City: L GPS State: Addres
Zip Code: Fax: City: State:_
Phone
E -Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E -Mail a �2
from the Owner listed above) State orCount U en$e 0a
If value of construction is 2500 or more, a RECORDED Notice of Commencement is re fired.
DESIGNER/ENGINEER: of Applicable
MORTGAGE COMPANY: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 Count yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in coMlict with any applicable Home Owners Association rules, bylaws orang 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 concurrencyreview: 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, con ult with lender or an attorney before
co mencin work or recordin our Notice of Commencement.
/ I I 44�l�
s
'gn re of Owner/Lessee/contractor as Agent for Owner
tZt,—
Signature of Contractor/License Holder
STATE OF FLORID L LKS
�L
OF
COUNTY
COUNTY OF
OFORIDA
The for oing instrument was acknowledg efore me
this5,dayof 2 y
The forgoing instr ment as acknowledg efore me
jLJOdL1
this d yo rV[ 20 by
Rall (-Q�J'l�,r.1/.�P./i
Nam per on making statement, li
�1
i
ame of person kingzstatemgtsysb— — —
-!_e SANDY CROGiVl 01�
Personally Known OR Pr ifeec���aerQ�Ad ra of Florida
ersonally Known cfAbJ fl6 VwbFlorida
Type of IdentificationF.- Commission # FF 177233
ype of Identification Commission # FF 177233
-iui�mm.
Produced +F..L�L-- ^, ,omm. Expires Feb 6, 201
roduced o-° Expires Feb 6, 2019
(Signature of Notifry?ubl -.State of Fibrida)
(Signature of Notary Public- State of F16ricla)
Commission No. 2 -(e - 61 (Seal)Commission
No. - 1 (Seal)
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