HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO KE ACCEPTED
Date: Permit Number:
T
Building Permit Application
Planning and Development Services
Budding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: ha
Address: r l, ',G?
Legal Description:
Property Tax ID##: ;��Gl/CI Lot No.
,r
Site Plan Name: Block No.
. b
Project Name:
Setbacks Front_.. Back: Right Side: left Side:
Additional work o be performed under this perms -check all that apply:
—mechanical _ as Tank _Gas Piping Shutters Windows/Doors
Electric robin '� rink(ers Generator Roof Pitch
e �;
Total Sq. Ft of Cons trt ctlon:1 Sq.Ft.of First Floor:
Cost of Construction:$ /0ar Utilities: _Sewer _Septic Building Height:
Name Name:
Address: Company:
Gity: 5ta Address:
Zip Code: 314!M 2 Fax: City: ff�I. State:
Phone No. � >- _5, l r am.-- f Zip Code: !2 5--3 Fax:
E-Mail: Phone No -
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or county License
If value of construction is 200 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER; Not Applicable
m MORTGAGE COMPANY: �Not Applicab Nae: Name-
Address: Address: le
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.
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 buiid the subject.structure
which is in conflict with any appiicabie.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 ith lender or an attorney before
commencing war ordlng your Notice of Commenceme
Signatur owne s r as ent o 4tu4rie4f ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF_ff1W JASag _ COUNTYOFF► �•U�\ _._.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-M day of 20_Zb by this %S day of___- iou- 20 0-0 by
(Name of per on ack edging) (name of erso c n ledgin
(Signature of Notary P Olio-State of Florida) (Signature of Notary Public-State of Florlc�ow NJI�f�
Personally Known OR Produced Id Personally Known OR Produ li dip
Type of identificationGi— Identification • p�r•
Produced TXLA VM5 S°t �����\`��, '0 4M �oo��� Produced
Commission No. GC%g ) °ta Commission No. "%'{S •..(Se� �-
Z?e5i-!"� w o
28546 ��i QP 'o I)dc
REVIEWS FRONT ZON IW
�y•. SUF?• PLANS VEGETATION SEA TURTLE CIVE
COUNTER R E V I E o�Apu :REi q�'A REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED J_
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