HomeMy WebLinkAboutBuilding Permit Applicationif APPLICABLE Fr MUST E OMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: ' � _ 1 Permit Number: 1
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
PERMIT APPLICATION FOR:
Address: L0
Legal Description:
rl&c�
Property Tax ID #: d 0o v Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Haaitionai worK to De perrormea unaer tnis permit - cnecK aii inat apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:® S°4 -F�y Sq. Ft. of First Floor:
Cost of Construction: $ _ SCii� Utilities: —Sewer —Septic
Windows/Doors
Roof Pitch
Building Height:
OWN ER/LESSEE:
C(+�NTROOKOR-
Name 6 iC-'J f
Address: 2�1 Cify' �� /
Name: � �,c
P_
Company: � � Q S[4 l9 S �-vc
City: FA Pa erc't State:_
Address:r A'J'C'
City: _ `J'e-U'Of- h c&f State:
Zip Code: Fax:
Zip Code: 3Fax:
Phone No. A,
E-Mail: NQ
Phone No 1)%&
Fill in fee simple Title Holder on next page ( if different
E-Mail M:Z °I Q`I &( Co, `' A
State or County License t& iSlr ZA 3
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
Sl.1�PPLfI`+7ENTA[. CONSTRi1(:TIaN l.tEN I�,�UV INF®RMAT'I0
DESIGNER/ENGINEER:
Name: o r
Address: O
_ Not Applicable
S ct S
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: \f 4:f o Pct
State: T=-
City: State:
Zip: ,T� 6 Z 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 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
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
commencingz work or recordinl7 vour Notice of Commencement.
Signature of Owner/
C
as Agent for Owner I Signature of Contractor/Li MTkVolder
STATE OF FLCIAIDA STATE OF FLORIDA �
COUNTY OF I &C-A- 6 COUNTY OF —�
The for ng instryKaent was acknowledged -before efore me
this day of by
(Name of person acknowledging)
(Signature of Notary IPublic- State of Florida )
The fgr o' g instru t was acknowledged before me
this It day of Qi 20O by
�A
(Name of person acknowledging)
c� n�s=aj A M
(Signature of Not V,
Public- State of Florida )
PeTisonally Known \— OR Produced Identification Personally Know
Type of IdBAW—i ut1o'n , Type-of-td ntiftt:
Produced Produced
,,,,,,„ ANG M HUFF
e .aav r��•p.
Commission No:i% d`�: Notary Public ate'pf Florida Commission No.
mission NV34730
10 Z My Comm. Expires May 27, 2019
OR Produced Identification
NN ki-A M HUFF
Notary Public - State of Florida
Commiss(fie* 234730
'Uy Comm. Expires May 27, 2019
Bonded through National Notary Ac—
on(
ed 1111 aug, 1
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Rev. 7/2014