HomeMy WebLinkAboutBUIDING PERMIT APPLICATIONAll APPLICCA��BLIIE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _-D " l 2_ C')O Q. Permit Number:
•
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 TYPE: 3 IQ r
PROPOSED IMPROVEMENT LOCATION:
Address: , 6 3(�6 C rh *_� r SCOT
Property Tax ID ##: 1 3<) i Gn 9 0 0 —1 f oo Lot No.
Site Plan Name: SAS r Block No.
Project Name: 70
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be performed under this permit —check all that apply;
_Mechanical Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER; _Not Applicable
Name:_
Address:
City:
Zip:
Phon
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City.
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
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 Count 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 JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
"J
Signature of Owner/ Lessee n ractor as gent far owner Signature of Cont'ractdr/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF `3y �,Uc �, COUNTY OF UC I IL
The forgoing instr meat was cknowledged before me
this !_�L day of u U " 26a by
Name of person making statement.
Wally Kno-v-
Ah OR Produced Identification
Type of Identification
Produced
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(Signature of Notary P{{uu�bli - S to of Florida )
Commission No. '1 (Seal)
REVIEWS FF
CO
DATE -
RECEIVED
DATE
COMPLETED 1
The forgoing ins ment was a knowledged before me
this day of W-1 U 20a b
Name of person making statement. _
OR Produced Identification
Type�o Identification
Produced
yy\r
(Signature of Notary
�� ub c- State of Florida )
Commission No.l_ (
Nolary%.b is Stilts of Florida
— — Kimberly Large
yand' Expires 1
PLANS VEGETATION
REVIEW REVIEW I REVIEW �