HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO.MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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III ISIu f l d i U li g Permit Ap p i l c a t i o k1 Il
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
PERMIT APPLICATION FOR: J0CL n GC is C
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Des
I
Property Tax ID #: " 1 ' 1 Y D 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
V-PDbC- wo h-Q-0b)t 3 0 �rX I 1 0 n e- /P It -
CONSTRUCTION INFORMATION:
Additional work to be performed un er t as permit— c ec all that apply-
-Mechanical — Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric Plumbing Sprinklers — Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ O� •a Utilities: —Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Q ` Name: Cep
Address: i 3 Company: t^Q i
City: �Q r i Q Sta e: Address: / 'Klk 4
Zip Coder l Fax: City: �7 , !ll',, State:
Phone No. _}'7 d A ��a- q 7� Zip Code.: I I Fax: I`7 -�_-k2 - a/
E-Mail: r1 Phone No a- ^ Q% S
Fill in fee simple Title Holder on next page ( if different E-Mail kCh80 g" ' +
from the Owner listed above) State or County I.i ense e �
If value of construction is 2500 or more, a RECORDED Notice of commencement is required.
SUPPLEMENTAL CONSTRUCTION: LIEN LAW II1IfDP.MA-11ON:
DESIGNER/ENGINEER:
Name:_
Address:
City:
Zip:
Not Applicable MORTGAGE COMPANY: Not Applicable
Name:
Address:
State: City: State:
Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:
Zip:_
Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
l 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-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improveme your property. A Notice of Commencement must be recorded and posted the jobsite
befor e first i spection. If you intend to obtain financing, consult with lender or a before
com f encinV r;k or,recordinp our Notice of Commencement. / �—
of
as Agent for Owner
Ider
SATE OF F€iRl l t STATE OF FLOA /
COUNTYOF r�(�' ar� lid COUNTY OF_J_�•�x����,-,
The f�rqoing instrument was acknowledg d before me
this 5t l- day of J 205 by
(Named pin acknowledging I
(signature of
Personally Known
Type of Identifical
Produced I
Commission No.
Florida }
OR Produced Identification
REVIEWS I FRONT
COUNTER
DATE
RECEIVED
DATE
NotanLiRubk_9tate of Florida
Pamela Dyer -Rape
My Commhslon��,, 7a5t3115
ExAli8.66j12ft•22' '1!
The forgoing instrument was acknowledged before me
this I day of i 11� 2% by
(NTEEC'nV
(Signature of No Publi
\ - State o lorida }
Personally Known OR Produced identification
Type of identification
Produced
,err Notary Public state of Frorida
Commission No. t �''�mm
am� Dyer-H� ,,aljj
yinion GV 26bt 1
_NJZJf Elpims0191OW022
ZONING REVIEW 15 UPERVISREVIEWOR I REV EW j V REVIEW ON I S ATURTREV EWES REVEWVE