HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I b�'�i• V��V
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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:
PRUPOSED fNPROUEMENT WRO ITI 1,
Address: 8140 %1l1
Legal Description:
Property Tax ID#: I O 1. 6038 ' 0004 Lot No.
Site Plan Name: Block No.
Project Name:
setbacks Front Back: Right Side: Left Side:
D AILED DESSPJT1tO,N tJF WORK:
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c1clitional work to be pertormed under this permit–check all that 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:
Cost of Construction: $ I OO' 00 Utilities: —Sewer —Septic Building Height:
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O ER/LLNSSEE: CONTRACTOR:
Name W'c�n oaR� Name:
Address:_ C;�5__? la i yy • rl i �r• Company:
City: it�. �-25,��- State ° `Wd'ffress'°"
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'Zip Code: %'-Al1gc) Fax: City: State:
Phone No. `��� 3 kq �`���1 Zip Code: Fax:
E-Mail: SOn\C 99�)Q� Aok - 03 Phone No
!Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above). State or County License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL C�NSRU1"I®!� LIf,N LAW 1NF®RMATI2N:
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
commencing work or.recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA�` ` STATE OF FLORIDA
COUNTY OF S�ty%,e`Q . COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day o 201$ by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
&aat�_
ign ture of Notary Public-Mate of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR_Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �lotary P bhc State of Flo,
` Produced
•„ ; My Comm.Expires Dee 20,2 I v
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C mission #FF 17724
Commission No. -1,� FF��;;' �Se�9� mission No. (Seal)
one through National Notary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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