HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE IN`F'O) MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I �f
Date: I T Permit Number:
� E' f-
Building Permit Application Noy�0�7
Planning and Development Services 1.4
Building and Code Regulation Division S F'ERIWiTTING
2300 Virginia Avenue, Fort.Pierce FL 34982 L cie County, FL
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION
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Property Tax ID #: CX`J,C) U - Vu l — --)U I Q-
Site Plan NaD
Project Name:
Setbacks Front Back: Right Side
Left Side:
Lot No. C) r
Block No. 91
��iS fiCn �- �45 ,1-o ; �3 rv4 t
Aaaitionai worK to De
E1HVAC
errorrneo
unaer znis perms necK ail apply:
❑Windows/Doors
Gas Tank
as Piping
_ Shutters
Electric _
Plumbing
ESprinklers
E:] Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S . Ft. of First Floor:` r
i• '
Cost of Construction:.$ �v�Cl si'V
Utilities:�Sewer❑Septic,
Building Height:
�®11UNERA/LE; lu"R-
CONTRACT®-R':.
Name 4
Address:90�15 ' M o' jL ' %�
Company:
City: State
Address O�
City: 1
Stater
��
Zip Code: Fax: -1� q-3 �:�Q1() t
- Phone No. �- �
Zi • Code: Q
p
Fax: �� -'
E-Mail:
Phone No7
Fill in fee simple Title Holder on next page (. if di ere ryl
E-M il:
f1 00.
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:' _ Not Applicable
Name:
Address:
city:
Zip: Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
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
commencj.ra work or recording vour Notice of Commencement. _
ature of Owner
as Agent for Owner / I -Signature of
STATE OF FLORIDtrr. STATE OF FLORIW1I 1 0 ,�
COUNTY OF COUNTY OF Liu
Tht �� mstru W acknowled4 fore me
this ( d y of 201 1by
Name of p r making statement
Personally Known OR Produced Identification
Type Id ntg ificatio I
Producc ed �^ W� Ow o
W.
The#erpgirD"rument 's n�wledg�ed-{aefore me
this (( 'day of LO 20_�by
I LOWS 1310 ILDW L-,%
Name of persmaking statement
Personally Known JJCC OR Produced Identification
Type of Identifi ati n 1
Produced
(i otary Public -Nate of Florida)
(Sign' aaTure of Notary Public- State of Florida )
P��c
Commission No.
JENNIFERCORSON
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Commission No..aF:•'•'••
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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. 8/2/17