HomeMy WebLinkAboutBuilding Permit Application IP
All APPLICABLE INFO MUST BE COMP AD D FOR APPLICATION TO BE ACCEPTED.
Date: PJ �• �'v7 Permit Number:
per 4- RECE
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-- Building Permit Ap9 plicat APR I
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Planning and Development Services C e Case. „ o i t
Building and Code Regulation Division ��"�� 1
._2300 Virginia Avenue;Fort-Pierce-FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential —�
PERMIT APPLICATION FOR:
Address: V
Legal Description: �
Property Tax ID#: 0 Lot No.
Site Plan Name: Block No.
Project Name: rD •��
Setbacks Fronija I Back: N Right Side: Left Side:
NJ VV-
N t \1 V W owc M _
Additionalworkto a performed un er t is permit-c ec a t at 1p
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors .
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor: 77
Cost of Construction:$ ,::::2 i� 0 • (� l� . Utilities: _Sewer _Septic Building Height:
Name Name:
Address: 1 P z 7M, Y3 1 Company:
'n
City: F+ 1VirY-cr, State:a Address:
Zip Code: `3'f�i 51 Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: c S +^ ►� ' +P 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 2500 or more,a RECORDED Notice of'Commencement is required.
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DESIGNER/ENGINEE _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: on Addresss: '
City: State:< - City: State:
Zip: n Phone' `77 7 D 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
commencing work or recording our Notice of Commencement.
Signature of wner/Lessee/Contractor as Agent for Ow er Signature of Contractor/License Holder
STATE OF FLORIDA TE OF FLORIDA
COUNTY OF C UNTY OF
Wg
The forgoing instr ent was acknowledged_Defore me forgoing instrument was acknowledged before me
this day of 20_ by day of .20_ by
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Na a of person ack wj dging) -T me of person acknowledging)
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(Signature of N ry Public-State of Florfcfa) ,; ignature of Notary Public-State'of Florida)
Personally Known S OR Produced Identification Personally Known I OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. ��