HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 's— i 0 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:
PROPOSED INPROVE MENT LOCATIONS �IN
.
Address:i)
Legal Description:
Property Tax lD #: t LA 9� 3 - So Lo - C)C S 000 - H Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
€bona wor to e per orme un er t is permit -- check all that apply:
Mechanical Gas Tank _ Gas Piping — Shutters
Electric T Plumbing — Sprinklers
Total Sq. Ft of Construction;
Cost of Construction: $ a { (C)i(�
Generator
Sq. Ft. of First Floor:
Utilities:
Name tKNO LC"A0(_F_'(_Ce_C
Address: 3 LPC ch r u 1�
City: C-loct S VI I State: aL
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Zip Code: Fax: ¢¢
Phone No. 9 31 - D -OL > - C) 0 O
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Pitch
Sewer _ Septic Building Height:
Name: ` u_ I�
Company:CZ6 1 1 r O� k_Ak (-,LS Ot EC
Address: (pgc)J CC'IQC)C�- Lor—le
City: C State: moi_
zip Code: J491s1 Fax: TL - LS398'
Phone No MD— b3L-{-t CSC i�
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E -Mail cQo c,lr 5 i1� i►4 C -
State or County License C '� {
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
l I f l l TA C7NSTRL1CTIt7N LIEN LAW INFQRM'ATIQN
DESIGNER/ENGINEER: Nat 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, wails, 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.
Signature aOwner/ Lessee/Un ctor as Agent for owner
Signature of ontractor/Lice s Hader
STATE OF FLODA
STATE OF FLORIDA
COUNTY OF _I ± : �_,)c \ e—
COUNTY OF 5�, l_ uc
The forgoing instrument was acknowledged before me
The for instrument was acknowledged before me
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tv ay of fi ; 1 20 I� by
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(Name of)person acknowle ing)
(Name of pdson acknowled )
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(Signature of N Lary Public- State of Florida )
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(Signature of Notary Public- State of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced IdentificationC
Type of Identification
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Type of Identificatio
Produced
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