HomeMy WebLinkAboutPERMIT APPLICATIONAll APPLICAB E 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:
Address: I In r
Legal Description:
Property Tax ID #: a(A 000 Lot No'
—
Site Plan Name: 0 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIL�I ES _91t ION OF rMORK:
h n i ra- F-�i�, n n �n/l I,/,III i f' %l U .('i A 1 11 1 '% 1 4 V it CY i `s i (f I� j `�_
Total Sq. Ft of Constructiorn-:�, ,
Cost of Construction: $ C _46 D_
Sq. Ft. of First Floor: _
Utilities: —Sewer —Septic
Building Height:
' c "l�; E S E: 1
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Name2Ja,A 1) 0_4'X J ON t JA
Name:
Address: C;CCompany:
City: �- Sta
Address:
Zip Code Fax:
City: Sta
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Zip Code8 Fax:
Phone No.-) rri. W
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E-Mail:
Phone No`
Fill in fee simple Title Holder on next page (if different
E-Mail
State or County LicenseCf-C C)
from the Owner listed above)
if value of construction is Z5uu or more, a KW_VKiJtV IMUTAVC v1 will$��C.wva��v.� •� .cy.... +-
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
RESIGNER/ENGINEER: Not Applicable
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 Applicable
Name:
Address: -
City:
Address.
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 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 wort;
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 FOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT!'
jSignature of Owner/ Lessee/Contractor as g ntfor Owner
Signature of Contractor/License Holder j I
STATE OF FLORIDA )
STATE OF FLORIDA��
1A
COUNTY OF Gip
COUNTY OF Iji-, &I
I The forgoing instill ent was acknowledge before me
The forgoing instr ent was acknowledged before me
IR 2by
this } j' day of 1 / 20 by
this day of 5fi
'7,
Name of person making statement.
Name of person making sWtement. j
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification {
Produced
Produced
L
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(Signaturre off Notary Publi;oft
rof Not ry Public- State of
/ o001% Notary Public Stale of Florid
Commission No. l�r r ? (S° +rsa L Butterfield
ommrssion GG 302065
jnat'Ue
mission No. lf)� ` = eal)A±e`'ssa L Pw:>rFesi
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Expres D2114r2a23
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 2/ 7/19