HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
PERM ITIAPPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: C01 15o'" C 2A�t�� Biu
Legal Description: t a 35 3G 9400 i of E '/,g o� 3e1�4 6� SI '),ei LP-S3
30 FT A\ LES F-y LES5 - 5 N o2 y 5- 9- -1('AC
Property Tax ID#: �1c�- 1 -6(3(5� ' � d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional wor to be nertormed under trils permit-c ec all appy:
I=_JHVAC Gas Tank ❑Gas Piping Shutters a Windows/Doors
Electric 0 Plumbing .Sprinklers MGenerator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ � .$ Utilities: Sewer Septic Building Height:
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Name 5 Vf_►'Q l(dfS rm F4 pryq C0.__JL r, Name:
Address:`(('1 60X C1 Io Company: M(�+M(\ _ ElecAoL
City: Belle Glade- State:A Address: 1010- t
Zip Code: 3-4-W) Fax: City: R_ -I 1(ypO State:F1
Phone No. Zip Code: pl�'-IgS;L Fax: r1`1a-yLol-4(_095
E-Mail: I Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: GSI, co
from the Owner listed above) State or County License:
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
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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' 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 thepermit 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
commencingwork or recordingour Notice of.Commencement.
Signa f Owner/Lessee/•ontractor as Agent for Owner Signatu f Contractor Lice se older
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFCOUNTY OF
Theorgoing instr ent was acknowledg before me The forgoing instrument was acknowledged before me
this day of 20 N by this day of 20_ by
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Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produc d Produced
igna ur of Notary Public-State f Florida) (Signature of Notary Public-State of Florida)
Commission No. ommission No. (Seal)
p LASHAHNAINGRAM•RAHMMG
S' • , w COMMISSION 0 GG 275060
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REVIEWS FRON PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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