HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLE1, . FOR APPLICATION TO BE ACCEPTED. f
Date: Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, FortPierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: (6d A are_e,
Legal Description:
RECEIVE-0 JUL 17 2017
Building Permit Application
Commercial
t v,
Residential
Property Tax ID #: l 3 0 l,Q '7 Q l l cl D 0 0 '7 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No..
_Mechanical _ Gas Tank _ Gas Piping _ Shutters --Windows/Doors .
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $ .360< °__0
Sq. Ft. of First Floor:
Utilities: _ Sewer —Septic Building Height:
Name ���,� G� �. �ra %r- Name:
Address: 611,01 Company:
City: A-1 Stater Address;.
Zip Code: 3 (�Z�' / Fax: City: State:
Phone No. 717 Z S Z 9 - 1129 Zip Code: Fax:
� Phone No
E-Mail: I'( /C11%l'//���l�r� ,/ /� �icc�, �'v�
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not
MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State'
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address: -
City:
Zip: 'Phone•
BONDING COMPANY: Not Applicable
Name:
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 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 jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
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Signature of Owner/ Lessee Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF Sk . Ly�-� �.
COUNTY OF
The.forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this IG 'day of , 20j by
this day of . 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Pub Ic- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification .
Personally Known OR Produced Identification
Type of ldentifcation
Type of Identification
Produced �.
Produced
' r ,B M CO NA MA NI # G.022023
Commission No. = .. tp
Commission No. (Seal)
EXPIRES: t)0wmber 16, 2020
Bonded 7hru Notary Public underwriters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
DATE
COMPLETED
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