Loading...
HomeMy WebLinkAboutBUILDING PERMIT APP QUICKAll APPLICABLE INFO MUST BE COMPLETE© FOR APPLICATION TO BE ACCEPTED Date: 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: Address: Lr) I () � j I Legal Description: _k( M Commercial Residential 11 Property Tax ID #: 4 () '�L P 0 _b (P 00- Site Plan Name: �' ProjectName: Setbacks Front 1 Back: Right Side: _ Left Side: Lot No. Block No. CC31$Z"RiCT1+QN IFORl1t'lTiflN' itiona wor to e pe orme uncler this permit- check all that apply: ,Mechanical _ Gas Tank _ Gas Piping T Shutters _ Windows/Doors `Electric Plumbing _Sprinklers Generator Roof Pitch Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $T Utilities: _ Sewer _ Septic Building Height: Name y Address: City: / StaA Zip Cod :,->-,(° 9 3' 7. Fax: Phone No.'� `7 aal 0 ;aC)) �,-'2, E-Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) Name:—! Compan, Address: Zip Code: q Fax: Phone No ` l E-Mail State or County License0-P C' nS 2C) (Q If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: _ Not Applicable Name:_ Address: City: State: Zip: Phone FEE SIMPLE TITLE HOLDER _ _ Not.Applicabie Name: Address: City: Zip: Phone - MORTGAGE COMPANY: Name: Not Applicable Address: City: Zip: Phone: State: BONDING COMPANY: Name. _Not Applicable 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 ail 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: roam 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 .DOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATi'ORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." i i Signature of Owner/ Lessee/Contractor as g fit for Owner Signature of contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA I )GI COUNTY OF JAIL e COUNTY OF C The forgoing instrIATent was acknowledge before me ` The forgoing inst ent was acknowledged before me this � day of 2i}o by this day of 20{ by Name of person making statement. Name of person making statement_ i Personally Known CJ OR Produced identification Personally Known 0 OR Produced Identification Type of identification Type of Identification Produced Produced i. � .l.J�/ r' t�t' .-1 pF, f _,ft �•'yl��".t � :'i'�lL^_-�--_ j (Signaf re of Notary Pub{ic- St ttortda�},nnnrv�.�n/ L nature of Notary Public- State of n ga*'qr Notary Public State of Flona Commission Ala. , cr� IS n osa L Butterfield ` mmisaion GG 302065 �s *�rt'w La , a tr; c S �° r _ ,sa L Bu C on Na. missi1(f eal%', ss C1 L m ar ecar'Y i3pue502t1412023 '` Y}o n REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE ii MANGROVE i COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW MATE RECEIVED I DATE _ COMPLETED _ ev. Mw