HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE IN7MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t ,'t{�
Bate: �� (i Permit Number. (� '(D` D
Building Permit Application
Planning and Development services
i Building and Code Regulation division
2300 uhginiaAvenue,Fort Pierce FE 349,92
Phone:(M)462-M3 Fax:{772)462-1578 Commercial �"` Residential
PERMIT APPLICATION FOR: To Select from dropbox,click arrow at the end of Cine
PROPOSED IMPROVEMENT LOCATION:
Address I op
f �i -00 o
Legal Description:
Property Tax ID Loft No.
Site Plan Name: Block No_
Project Name:
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Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to ee rme u5-der-this permit-check all t=appy:
HVAC Gas Tarek Gas Piping Shutters FiWindows/Doors
Electric PiumbipOGenerator g []Sprinklers 0 Roof Rani pfth
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! Total Sq.Ft of Construction: i So.Ft.of First Floor:
Cost of Construction:$ ',--) � �— Utilities: ]Sewer nSeptie Building Height:
OWNER/LESSEE: 0_ `� v CONTRACTOR:
Name,LZ- oA5606,141" game: f�Z
Address: Company: t fife -[-1��
City: Stater Address.9P,50 N tG 16
Zip Code: Fax:4 City: W t4 M ! State.-,.E&
Phone No. ( Zip Code: 25;4'2. F TO 1 _
E-Mail: Phone No. �r�6:R ��E q�
Fill in fee simple Tittle Holder on next page{if different E-Mail- {m n � t
from the Owner rested above) I State or County License:
!f value of construction is$2500 or more,a RECORDED Native of Commencement is required.
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SUPPLEMENTAL C0MS�`�tCDCT SON L'INNAW.INFOR,,_ rI N
DESIGNER/ENGINEER: I Not Applicable MORTGAGE COMPANY:` _Not
Applicable
Name: Name:
Address: I Address:
City: I State: City: State:
Zip: Phone I Zip: Phone:
FEE SIMPLE I I I HOLDER: I Not Applicable BONDING COMP Not Applicable
Name: Name:
Address: i Address:
City: I City
Zip: Phone: I Zap: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I I certify that no work or installation as commenced prior to the issuance of a permit.
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St.LucieCoun makes no representation that is granting a permit will authorize theg2ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an(l 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
i in accordance with the approved planes,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 pool's,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 w4ce for
II improvements to your property,A Notice of Commencement must be recorded and posted on the;obsite
i before the•fi nspection.If you intend to obtain financing,consult nder or an attorney before
!"commencin w rk or our Notice of Commencement.
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I Signa ur o r Limse&CWc6r as Agent for Owner Signat ctortucense Holder
SPATE OF FLORIDA STATE OF FLORIDA �cy
COUNTY OF L_• COUNTY OF (CJ cc o
The forgoing hist. t ar�fedge re me The for Ding instrir n o ged,�efore me
�?day of K =! 20W" thiM day of� 261 by
C ent NVa�,z 0 ma/r 06"n',ollK Z
Name of person making statement Name of person mating statement
Personally Known OR uced Identification Personally Known OR Produced Identification
Type of Rd tion Type of ld do
t Produced �.1 �/5��� Produced 1��o
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(Signature of h&ry Public State of Florida) (Signature of Notily Public State of Florida j
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Commission No. Commission No. r
.,: GEQRGINAEL17ABETHCANALES �rurn '', (;MINA ELIZABETH CANALI
. ' .fi; Notary Public-State of Florida "�� �@ Notatypubiic-5tateofFtorid�
` ` tom mission GG 124400 '• a Commission#GG1144o0
IGp „ •, .;
Comm.ExpiresNov ";,;,;,;y,, Nan 2hraugh Fia6&Nov lar
REVIEWS F� N n onaiN ISOR PLANS VEGETATION
R I REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED':
DATE
COMPLETED
Rev.8J2J17
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