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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: lC Permit Number: Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 PERMIT APPLICATION FOR: Building Permit Application Commercial Residential >'}t tN'[JW [NPftPVEMENT LOCATION,;,= s i Address: !'911.77 j" 61, Legal Description: C Ic ��- Property Tax ID #: �y c �J �� (� 9 -._ 0616 Lot No. cv Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: {?i7tliNEIRLESSEE .'> CONTRA1'Dl Name Name: ( t " i Address' OnC ' v—, Compan` . +n City: State: �_ Address: - Zip Code: % Fax: City: ('C..re- State: 5'L. Phone No. ] ` % -r.j Zip Code: ���— Fax: Phone No E-Mail: = 4C, rz--e E-Mail / r � Fill in fee simple Title Holder on next page ( if different from the Owner listed above) State or County Licensee gr—G. 4JS—R' © Gl4::� f value of construction is 2500 or more. a RECORDFn NntirP of r'nmmonromcnt ie rcnui—el SUPPLEMENTAL CONSTRUCClON LIEN LAW INFORMATION: rDESIGNER/ENGINEER: _ NotApplicable Name: - MORTGAGE COMPANY: Not Applicable Name: Address: Address: City: State: Zip: Phone City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not;Applicable,- Name: BONDING COMPANY: _Not Appiicable Name: Address: City: Address: i�._ 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 Counttyy 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 Wtirn YOUR i FNF3FP nu aN ATiORNF'Y RFFnRF 17FCORn1NG YOUR NOTICE OF COMMENCEMENT_" �i Signature of Owner/ Lessee/Contractor as g ntfor Owner I Signature of Contractor/License Holder f STATE OF FLORIDA � �'! STATE OF FLORI!?A,�_ rr COUNTY OF tA_ COUNTY OF, The forgoing instrtt ent was acknowledged before me this day of i 1 20c�l by The forgoing instrWent was acknowledged before me + this j,�_ day of 20 w (( by _ �'Zbfr4-1/1 f � Name of person making statement. Name of person making st;dtement" Personally Known 6 OR Produced Identification Personally Known OR Produced Identification Type of Identification Type of identification Prod aced Produced (Signat re of Notary Public- St nature of Notary Public- State of v /` / n _ o�Ys�s tdo.ery Pu6Us State of Fiond r t � _ .. / " _o`�•',e .. �o'�-y•�S':c S:a� c,t