HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I a -5. Permit Number:
Building Permit Application t10 n
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:
i�Ylg'mEII TTOP T1C3N� :
Address: L1 C-)i C
Legal Description:C(' ,—"Q�j'ono6s
Property Tax ID#: Li ! ('*Na 00 03 , 000 — Lot No. .�t
Site Plan Name: Block No.�J
Project Name:
Setbacks Front Back: Right Side: Left Side:
�CSTftli.t3 F311 ; Tfl1 «, f
Additional worK to be performed un ert is permit—c ec a t at app y:
Mechanical _GGasTank `Gas Piping _Shutters _Windows/Doors
Electric )e Plumbing ._Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ j( Utilities: Sewer _Septic Building Height:
".....�"' .+;ne, p st 's'�""�•"'"u�'J .-ur Y
Named w Name:
Address: -� Company:
City. rr' S' Address:
Zip Code. ti 1 Fax ,, City. _,�' St
Phone No.7n �� tom — Zip Code - Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mali
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUIETiON LIEN LAW INFORMATiON'
6ESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: - Name:
Address: Address:
City: State: 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:
Ay
Ri 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+ orl:
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 COMMENiCEMENT MAY RESULT IN YOUR PAYING
TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE RECORDED AND
POSTED ON THE JOB SiiE 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 as g�ntfor Owner Signature of Contractor/License Holder f i
{ I
STATE OF FLORIDA,,.�.}} � STATE OF FLORIDA
COUNTY OF II wit ai CA e_ COUNTY OF - 1A1LI
The forgoing instru lent was acknowledged before me The forgoing instr ent was acknowledged before me
this 3 day of i J0 V` 20M by this day of
p 20 I by
Name of person making statement. Name of person making stdtement- ;
j Personally Known OR Produced Identification Personally Known OR Produced Identification
f Type of Identification L Type of Identification {
Produced Produced }
{Signat re of Notary Public-St nature of Notary Public-State of
~✓ qa* v�, Notary Public State d Florio `. osY+u o , Ut S z n
° sa L Bull r6etd 7 ,. ±� spa L Bu} r+a b
Commission No. ,� 3r�i�; r(5 � C mission No. #)+ eal)
arnmission G6 302.065
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I
RECEIVED !
I DATE j
COMPLETED
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