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 Development5ervlce5
BuJiding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1579 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED INP.ROVEME TLOCAT-t9.
Address: r . �Gr+_
Legal Description: 3w(? 75'/1) b .7 9- a 0 Q
Property Tax ID#: Lot No,
Site Plan Name: Block No.
Project Name: _ �(�.ra
Setbacks Front _ Back: Right Side:_ _ Left Side:
I ' AI .0SeRIFTKQN OF uua
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Ca•NSTRUCI"lOftili: MFARMATIUN:::':
+ ono worko b e pe orme un••er s permit-check a at apply:
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_Mechanical Gas Tank _Gas Piping _Shutters Windows/Doors
Electric _Plumbing ^Sprinklers !Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
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MNER/LeS,SE•E: t
Name Name: 1
Addre ' Company: ;�n
City: State: L Addre
7jp Code: Fax: City: N f State'
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Phone No. zip Code: Fax:
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Phone No.simple Title Holder on next page(If different - a
wner fist¢d above) State or ounty License:
If value of construction is Z500 fr more,a RECORDED Notice of ommencement Is required.
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S.UPPI: (YNfiAI,-�CONSTRUfION lN:t +►UV INf=CIRM1`fIN.
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip:.---_-_--_-.._ .- Phone: • Zip: Phone:
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FEE SIMPLE TITLE NOLDER: _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 make$no representation that is granting a permit will authorize the ermit holder to build the subject structure
which Is in con lct with any applicable Home Owners Association rules,bylaws or ae f covenanou that may restrict or prohibit such
structure.Please consult au your Homo Owners Association and review your deed ffor 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 f ion. If you intend to obtain financing, consult with lender or an attorney before
..commeyr6ingm, arl our Notice of Commencement.
Signature of Owner/Agent/Lessee S e o Contractor/License Holder
STATE OF FLORIDA STATE OF FLORI
COUNTY OF COUNTYOF Ck••Nf 1_4eWG
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The for ping instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9 day of_ rGh ,2Q� by this!day of_. 22(,jreh 2oa-( t)y
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(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida}
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Personally Known�ProdOR Produced identification Personally Known OR
ion Produced Identification
Type of Identificatuced � Type of identification Produced____
Commission No. � v►' j)Notary Public Stilts or le XWM ssion Nob-680101 a �„ „(Se ,a�v Pubrio stole of FI
Christine Holland R, C.'hristine Holland
My Commik►lon GG Ot My Commission G(i 32870/
REVIEWS FRONT Z I E I R S V£GETATI4N SEA TURTLE
COUNTER----REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE - —
RECEIVED
DATE
COMPLETED
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