HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIOWTO BE ACCEPTED
Date: 3 1� 5 Permit Number: 5 b 3� d a5
RECErvS0 BAR 16
�i'� Buildin Permit Application
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bPlanning and Development Services '
Building and Code Regulation Division I
2300 Virginia Avenue, Fort Pierce FL 34982'
Phone: (772) 462-1553 Fax: (772) 4624578 Commercial Residential
PERMIT APPLICATION FOR: TJQE$ r5kTnFdFQbdP8IQfCLICK HERE
PROPOSED.'IN'PROVEM`ENT LOCAThON ...^C s .
Address: O20e*�<w
Legal Description:
Property Tax I D #: d=-,Yd- U S U
Site Plan Name:
Project Name:
Setbacks Frona>iBack:
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Right Side: Left Side:
DETAILED DESCRIPTION OF WORK r F v .5a .r 'tra
C(JIVSTRUCTION;INFQRMATION`
Lot No. I
Block No.
Additional work to be nertormed under tnis permit— cnecK ail apply:
a' HVAC L__I Gas Tank ❑Gas Piping _ Shutters Windows/Doors
L�J Electric Plumbing FSprinklers 1:1 Generator [9Roof
Total Sq. Ft of Construction: 97n S . Ft. of FirstMptic
Cost of Construction: $ vZS40 KUtilities:]Sewer Building Height:
01NNERjLESSEE
CONTRACTOR
:'
Name G�t.1rC
Name:
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Address:1?DDD Tf�,07e�s L,K
Company:
City: F2, Pkeze�E State:'
Address:
Zip Code: ;y94s Fax:
City: State:
Phone No. %% .2
Zip Code: Fax:
E-Mail: I
Phone No.
Fill in fee simple Title Holder on next page (if different
E-Mail:
State or Cou y License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLE(VIENTAL CONN LIEN LAW INFORMATION;
STRUCTIO
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State: _
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
Name: _
Address:
City:_
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 your Notice of Commencement.
ignature of Owner/ Agent/ Lessee
STATE OF FLORIDA
COUNTYOF
The forgoing instrument was acknowled ed'before me
this XCday of M- r -fin 20M by
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of , 20= by
(Name of person acknowledging) (Name of person acknowledging)
0
0
(Signature of Notary blic- State of (Signature of Notary Public- State of Florida )
Personally Known OR Pr ce 4� �'i}t) cPersonally Known OR Produced Identification
Type of Identification Produced L `y �� Type of Identification Produced
� ��hp,�O Dr
Commission No. L 65 rc (S ad Commission No. (Seal)
Revised 07/15/2014 S A f.;.•
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