HomeMy WebLinkAboutBuilding Permit Application All APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date Permit Number:
RECEIVED FEB 14.2037
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: - 1
PRC
Al lIIP
6R01fEMENT L CAI"I f:
Address: �"I ra W VC Qf
Legal Description: i A
Property Tax ID#: - Lot No.
Site Plan Name: / Block No.
Project Name: / v
Setbacks Front Back: Right Side: Left Side: r.
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DETAILEb DESCoRCP ION` C) VIIORK:
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CONSTRlJCT1.ON FN'F®R(�/IATt®N:
Additional work to be pertormed under this,permit-check all that appy: i
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-Mechanical -Gas Tank —Gas Piping a 'SHutters Windows/Doors
_Electric Plumbing _Sprinklers s. Generator - Roof
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Tgtal( Sq.!ill of Construction: Sq. t°of�First Floor:: a 'Utilities:`
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Cost of`Csonstruction:$ / 9010.11 'Utilities ii _Sgwer) _Septic Building Height:
®WPI"ER/LE-�SS E: � �dNTRA�T'®R:
Name: I } Name:
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Address: 6 I" Company:
City: ` c t c�rcq State:_ Address: C to � NG
ZipI ode-e Fax: City: MIX tislt C�V@. State:
Phone No. t J r, Zip Code: 'Fax:
E-Nlaif Phone No
Fill in fee simple Title Holder on next page( if different 'E-Mail
from the Owner listed above) State or County License (,G(&
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
. StJ� PLEIVIENTAL= CO STR CTtON Lt;EN W I�Nt=O�R�NIATIQN:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: t IState:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMP NY: Not Applicable
Name: Name:
4-
-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
commencigg work or recording our Notice of Commencement.
Sign ure of Owner/Lessee/ ontractor as Agent for Owner SrUNTY
e of Contractor/License Holder
ST TE OF FLORIDA l '�t
SOF FLORIDA
COUNTY OF .�",U C OF
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The f. r oing instr t was acknowledge fo e .< ;The fof oing instru was acknowledged efoi a me
this L day of Q 20 ` by ro?� ^Qc' this f day of d Q� 20 by
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(Name of person acknowledging �• N (Name of person acknowledging)
N �'• A
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(Signa f Notary Public-State of Florida) o T T (Sign re of Notary Public-State of Florida) ti
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Personally Known OR Produced Identificil3tion r Personally Known OR Produced Identificat on
Type of Identification Type of Identification c
Produced Produced X 3 Z
C N Q 7
Commission No. C Seal) Commission No. (Seal) 3
0 14 U
65
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REVIEWS "°�FZ`b'Nf` '��Z N6NG SUPERVISOR PLANS VEGETATION— SEATURTLE M I%!*E
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW EVIE\A&
DATE
RECEIVED
DATE
COMPLETED
lev. 7/2014