HomeMy WebLinkAboutbuilding permitALL APPTICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
,rt"ffi PermitNumber:
Building Permit Application
Plonning ond Development Services
Building dnd Code Regulation Division
2300 Virginio Avenue, Fort Pierce FL i4982
Phone: (772) 462-7553 Fax: (772) 452-1578 Commercial Residentia
(
Address:
Legal Description
Site Plan Name:Block No.
Project Name:
Setbacks Front Back: _ Right Side:Left Side:
iY-c \u(-
appryltr
E
HVAC
Electric
Gas Tank
Plumbing
l-leas riping Shutters
Generator
fl*,noo*s/Doors
tr_[_lsprinkte.s tr tr Roof Roof pitch
Total Sq. Ft of Construction:
-
Sq.[! of Firslflqor:
-CostofConstruction:5@Utilities:Il,"*",E'.*Building Height:
Property Tax lD #:
ii vatue of construction is $2500 or more, a RECORDED Notice of Commencement is required.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
E-Mail:
State or County License:
ct'Q-*Zip Code:
Phone r.ro.-l"jZ- b2L- 7\5L
Fill in fee simple Title Holder on next pate ( if different
from the Owner listed above)
orste nrn/ENGINEER:
Name:
_ Not Applicable
Address:
City:Stat.e:
zip:Phone
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
City:State:
lip:
-Phone:
FEE SIMPLE TITTE HOLDER:
Name:
_ Not Applicable
Address:
City:
zip:Phone:
BONDING COMPANY:
-Not
Applicable
Name:
Address:
Zip:
-Phone:
OWNER/ CONTRACTOR AFFIDVIT: npplication is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
i,)r,[?ii3 fi".T,']f'Ii,$fti:?'i".'Jfi?31**'fi$lEb[H:?!'i!g"lBti#'lfixl:t;i:"'^,ra,!:if:5uL:3lgfil? H:\ii:!.,",i.1'JFili'iii,iHl".r'
iii.rii,ji".'pt"isi irjniiitt wittr"riririi Home owneis Association and review'your deed for any restrictions which may apply.
ln 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 ipproved 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
WARNTNG TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice.fo.r
improvements to Voul property. lwoti.e of Commencement must be recoided and iosted on the jobsite
betore the first inspection.'lf y6u intend to obtain financing, consult with lender or an attorney betore
commencine work'or recording vour Notice of Commencement.
aev. z/zltt
The fprgoing
thisSl day
ame of petsqn making statement
Known \L On Produced ldtPersonally Known Y*- OR Produced ldentification
Type of ldentification
re of Notary Public-
Name of pqrsoFt making statement
Personally Known Y= oR Produced ldentification
Type of ldentification
(Signature of Notary Public-
Lessee/Contractor as Agent for Owner
Iffi'3flIi,:ffieroreme
- CAT.HEBINE MILL
iz- s{&cdl F torida-Nora rv I
:E Commission # GG 273
My Commission Expi
,.CATHERINE MILS8ilot Florida-Notarv
Commission # GG 273
SEA TURTLE
REVIEW
DATE
COMPLETED