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HomeMy WebLinkAboutBuilding Permit Application I All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: 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 INAVE ENT L1CATI 0 Address: Legal Description: Property Tax ID#: 32405 91 L 660-1 00 01 Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: [=ALED DOE"N', PTION ®F WORK: CC+}NSTR ZTE, N F(JRMATION. Additional work to be pertormed under this permit-check all that a'pp y: _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:$ Utilities: _Se er _Septic Building Height: OWNER/L'S�SE CONTR CTOR. Name_i1;u h p-A Name: ` Address: /Z47-in b,&w dl- Compa y: P City:Ica- 4 34State: Address !OS h"7 Al U) -123 Zip Code: -2Atq bl'2 Fax: City: Ca ik Stater Phone No. I?Q,! , 1 - b? y`(57 Zip Cod Fax: g�3 E-Mail: Phone o Fill in fee simple Title Holder on next page(if different E-Mail- from the Owner listed above) State or'County License If value of construction is 2500 or more,a RECORDED Notice of Commence ent is required. S WAREMEN AL GONSTR+UCTION L!E LAW INf'©RMATlQN. 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. r - S' atur of Owneyf Less ee/C tractor 6s Agent for Owner Sig ure of Co tractor/. cense Holder STATE OF FLORIDA l STATE OF FLORID COUNTY OF ,►.e�,� _ COUNTY OF Q _ J The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20_ by this day of 20_ by Name person making statement. Name of person making statemen . v Personally Known OR Produced Identification j Personally Known OR Produced Identification Type of I nti natio Type of Iden on n Produced Produced1� �1J� (Si atu a of Notary Public-State Florida) gnature of Notary Public-St6e of Florida) "��"„ DASHAHNA At ""°,; ,ANN �INGRAM Commission No. VP's, Sea mmission No ,�r0a �� (Sea r `��: 'Notary Public-State of Florina `�: Nptary Public State of Florid OMM =• w•c,M 0 m•E My Comm.Expires Dec 20,20'8 �,9r oj, CO Nj9 0;: Com iission S 1 40 0. 0¢, m fission#FF 177 9£ "%'� F 0�`' , ��"i a As'n. REVIEWS FRONT "' (�IVII 000th oSUP,..E ,V PLANS VEGETATION SE°,4"`'FIJR�QWt•rc1 ��GR Y� Qr k sn COUNTER R�'� REVIEW PREVIEW REVIEW E E' REVIEW DATE RECEIVED DATE COMPLETED ev.