HomeMy WebLinkAboutBuilding Permit ApplicationAll 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
.2380 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: D c�SGS IF
Address:
Legal Description:
Residential
C—_ b,,�(- -
13
Property Tax 1D #: !Q, .}, "( "1 0_ —r�1 Lot No.
Site Plan Name: Block No.�
Project Name:
Setbacks Front Back: Right Side: Left Side:
onal worK to be pertormeci under trus permit — criecK all that apply:
_Mechanical ^ Gas Tank — Gas Piping Shutters
_ Electric Plumbing —Sprinklers _ Generator
r
Total Sq. Ft of Construction!: Sq. Ft. of First Floor:
Cost of Construction: $ 1 00 Utilities: `Sewer —Septic
Name
City: _ Fa C t i <a ,-0 �� State: P I
Zip Code: 5 411 '3- _ Fax: r_
Phone No.� 7r�'` �✓ r��� IS -Y
E -Mail: —
Fill in fee simple Title holder on next page ( if different
from the Owner listed above)
Name: V ail � Q
Company: Dc -LC
Windows/Doors
Roof Pitch
Building Height:
Address:. / S' /4 R I &c k_ e 0�d C) -
City: �6- pU P1e-A- State:[--/
Zip Code: 3,9-7 !.?,- Fax:
Phone No.
E-Mailc� CU�'1\
State or County license /
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Ia
� WN.
DE5ICNERIENGINEER: 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: T
Zip Phone-,
P - Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the worts and instauatton as maicatea.
1 certify that no worn or installation has commenced prior to the issuance of a permit
St Lode Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in ronflictwith any applicable Homeowners Association rules, bylaws or and covenants that may restrict or prohibit such
structure_ Please consult with your Home Owners Assoclation and review your deed for any restrictions which may apply.
in consideration ofthe granting of this requested permit, I do hereby agree that l will, in all respects, perforin the work
in accordance with the approved plans, the Florida Building Codes and 5t. Lucie County Amendments.
The €allowing building permit applications are exempt from undergoing a full concurrency review_ mom additions,
accessory structures, swirriming pools, fences, wails, signs, screen roams and accessory uses to another non-residential use
WARNING TO OWNER: Yourfaiture to Record a Nc ice of Commencement may result in your payingtwice fpr
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
Signature o owner/ Lessee/ tractor as Agent for Ovoner sWiSf6reV Contractor/license Halder
STATE OF FLORIDA I STATE OF FLORIDA ^I
COUNTYOF T I' ' COUNTY OF ',1 E / i'Gr\ 1q)` "qr—
7izefoainginstrume twos cknawledgedbefore me fheforoinginstru entw ackrtQwledgeclaeforeme
ti&is day of J 7 1 Y' 20 N by this / 1 day of , 20 I `'i by
Name of person making statement I lame of person maidngstatement
Personally Known >f� OR Produced Identification
Type of identification
(Signature of N?SIP
UT
My
Commission No.
REVIEWS IFRONT 17-ONING
COUNTER REVIEW
of Florida
Personally Known OR Produced Identfication
Type of Identification
Produced n
I -P(/
(Signature of Na-Steyi3tiW)�f Florida
* , Pame{e Deer-Hape
Commission Wo.
SUPERVISOR IPLANS I VEGETATION I SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW