HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICIBLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit Application
Manning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 62- / La J1 LILL �Go
Legal Description: 01eAnde..r -P,
Commercial
Property Tax ID #: noo V
Site Plan Name:
Project Name:
9--
Setbacks Front— Back: Right Side:
_ Left Side:
Residential
S- D -
Lot No. ±i�z-
Block No. I
v-e—
_Mechanical r Gas Tank Gas Piping — Shutters Windows/Doors
— Electric Plumbing Sprinklers — Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 1
Name
City: F - -4-
bc -- State:
Zip Code: 3-4_q,S-D- Fax:
Phone No. -7-7a-6 ,-7 A -.1JtW
.E -Mail:
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic
Fill in fee simple Title Holder un next page (if different
from the Owner listed above)
Name:.
Compa
Building Height:
(- h4 K,
Address: K)� I —'t� �,cf-h 0
City: Fol" State: V—t,
Zip Co,de: Fax:
Phone No -7-70,-3717 - 3 D-
E -M a il_J el fi, CO)
State or County License CKN26L13-;
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MOAT
Name:
Address:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
GAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
Not Applicable
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 accessory uses to another non -reside
"WARNING TO OWNER: YOUR Fj
TWICE FOR IMPROVEMENTS
POSTED ON , lE JOB SITE I
WIT"jYOUOXNDER OR AN I
of Owner/
TO RECORD A NOTICE OF COMMENCEMENT MAY
UR PROPERTY. A NOTICE OF COMMEN MENT
THE FIRST INSPECTION. IF YO INTE TO OBIEY BEFORE RECORDING YOUR II F COMMS
ntractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF—
The forgo.ng instrument w sacknowledged_before me
this day of /Voi/ 20 A? by
Name of person making statement
Personally Knowny
Type of Identification
Produced
(Signatu,rP,Aff Notary Pu
M
OR Produced Identification
Florida )
(Sea 1)
Signature of Contractor/Licens
I use
RESULT YOUR PAYING
MUST RECORDED AND
'AIN F ANCING, CONSULT
NCE NT."
STATE OF FLORIDA
COUNTY OF
The forgoing instrumet as acknowledged before me
this day of 20JI, by
Name of person making statement
Personally Known Lam'' OR Produced Identification
Type of Identification
Produced
f
(Sign atu re,,pfNotary Pub ' - Sta of Florida )
Commission No. Z (Seal)
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