HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:
PROPOSED INPROVEMET LOCATION'
Address: F_JD C1,49 11t1ldt Cyr L 3 9 ys.�-
Legal Description: .S4. .Lur-;-e Gay c�c,1�
Property Tax ID#: 3 a4 - Sod - b3 y 000 -3 Lot No.
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Site Plan Name: Al/ )'�- Block No.
Project Name: {�2 V
Setbacks Front Back: Right Side: Left Side:
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CONSTRUCTION INFORMATION.
Additional work to e performed un er t is permit-check all that app yy
_Mechanical _Ga's Tank _Gas Piping (1 Shutters Windows/Doors
Electric _ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction: $ Ll a a Utilities: _Sewer _Septic Building Height: .�s
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Name El' <-e C. Name: ha 01 !!S e-
Address: FLbr'r' a y,Compan as TR �u
City: PS L, State: /^ Address: 6P13Z )-G(C 2
Zip Code: .3g�s�- Fax: City: Jar, )ire rt--if State:
Phone No.77 - /-/e�a , �� Zip Code: ;StJ9 y G Fax:-/Z2- 4/
E-Mail: &UA Phone No. V- LW- �W 6
Fill in fee simple Title Holder on next page ( if different E-Mail: O w) . Jn , C & d o a. C D y►-Z
from the Owner listed above) State or County License: S CC 13 5 SD
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
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.
certify that ro 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
commencing work or recordin our Notice of Commencement.
Signature of Owner/Agent/Lessee igna ure of Contractor/License Holder
STATE OF FLORID } STATE OF FLORIDA
COUNTY OF � - i AC,(b COUNTY OF
The for ping instrljment was acknowledged before me The foW oing instr ent was acknowledged before me
this day of DECOAW @. 20 2-D by this -day of f t, 20 2D by
(Name of person acknowledging) (Name of person acknowledging)
ignature of r4odry ub ate of Florida ) (Sign re of Notary P lic Sta orida )
Personally Known OR Produced Identification Personally Known OR PLOduced Identifica io
Type of Identification Produced i milj}A iD�e atILCA S Type of Identification Produced �:LOIUOA Dt1%L
Commission No. 'Its �"C 1 Commission No. p`l�'[� Ic
pRLANDOVAZQUFZ QRLAN VAZQ01 da
State°4 Flo>ida State°�F4o"
_c.E' tar 4ublic- :�Pa�eve" Notary pu4�4tc- CG 169B41
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pins Feb 26.2� � = °prtm.Ex,ites l ot3rY5°.
REVIEWS FRONT "`":;E ."NfN �5n "Isu PLANS VEGETATlO "Tt�Y nN
COUNT R' EW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014