HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:Ao. 19• Permit Number:
gi '
D
_ Building Permit Applicatio018
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 Reside
PERMIT APPLICATION FOR:
Address: .90619 1 a ti
Legal Description:
Property Tax ID#: z o06 00 0 — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left.Side:
itiona wor to e-—performed under this permiW-c 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�0 0 Utilities: Sewer _Septic Building Height:
Name 04-8 - { U Name:
Addres D MUT C - Company:
P-3 City: L State:_ Address:
Zip Code: 9 'NO Fax: City: State:
Phone No. o - -,7364 Zip Code: Fax:
E-Mail: aye C�yt?C° -S'�- kJ9—F Phone No
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 Commencement is required.
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 accessoryuses 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 perty.A Notice of Commencement must be recorded and posted on the jobsite
befor the first insp ion. If you intend to obtain financing;consult with lender or an attorney before
com a cin work r reco ding your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for oinginstru ent w s acknowledged,before me The forgoing instrument was acknowledged before me
this day of 20 b by this day of ,20_ by
DENISE J.;. «o'=_ Notary Public R StSMETANA
ETANA
ate of Florida
(Name of person ac O e$ My Comm.Expires Jul il,2021 (Name of person acknowledging)
"oF
Banded through National NotaryAssn.
(Sig ature of otary Public-,State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification 11 Personally Known OR Produced Identification
Type of ldentifi ation Type of Identification
ProducedL. Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.