HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 APPLICATION FOR:
PENN
Address: rAc
Property Tax ID#: O -- Q Lot No.
Site Plan Name: )( Block No.
Project Name: ,41 `, h
Setbacks Front Back: Right Side: Left Side:
;Px
in c� iY1 f7 r✓ 4t 4/ l naots
Add
itiona wor to a per orme under this permit—check all that apply:
_Mechanical _Gas k --Sprinklers
Gas Piping _Shutters _Windows/Doors
—Electric lumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
Name 4rn,n t .4 Name:
Address Company:�t'yc�n
City: ee State:VZ- Address:qQ 151'- t
Zip Code: S S e� Fax: City: ` State: �L
Phone No. 7 7 G Y" U Zip Code:L K �L Fax:
E-Mails Phone No "�of `alf, tJZ Ll
Fill in fee simple Title Holder on next page(if different E-Mait'=V�I c--i jo cA_C� C L v�i
from the Owner listed above) State or County License L 1r C. U IFS 0 Le Y
Ltt
of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
UESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ,Not Applicable
Name: - Name:
Address: Address:
City SI:ate: 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.
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 Horne 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,malls,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 iMP'ROYEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
N POSTED ON THE.DOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT."
Signature of Owner/Lessee/Contractor asQeptfor Owner Signature of Contractor/License Holder 1
F STATE OF FLORIDA STATE OF FLORIDAe Jt
COUNTY OF IA1 Lf e COUNTY OF 11,tQ
The forgoing instrument was acknowledged before me The forgoing instr ent was acknowledged before me !
this day of 20M by this�day of4hi
1�S#' 20 c21 by
Name of person making statement. Name of person making slw tement.
Personally Known OR Produced Identification Personally Known OR Produced Identification f
Type of Identification Type of Identification
Produced Produced
f
(Signat re of Notary Public-St- t nature of Notary Public-State of
.0y1%. Notary Pubic State of Flontl s<ny La pub.�5 � --
r,� I "?° a sa L Butterfield „ 2° `� }r,te.spa L 8u i jeru
Commission No. d(Sommasion GG 302055 mission No. fa „
ara•.p Expires0211412023 'n.55 Gam: _7,
}or nar 02t7e2'+ 3 .
d, -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/19
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