HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /(J /
floll C� Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division (�
2300 Virginia Avenue, Fort Pierce FL 34982 Residential — \
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: 2 6, tAt
n
Legal Description: 1116 Q, TlaQ
Property Tax ID #: 1 421 702 Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
e r11 o11 a14,9(
-Totcln d owe.
❑HVAC U Gas Tank HGas Piping
❑Electric 0 Plumbing ❑Sprinklers
Total Sq. Ft of Construction: p'IfC56
Cost of Construction: $ / V
Windows/Doors
Roof
S Ft. of First Floor:
utilitiestSewer Septic Building Height:
Name 911 S 94 V
Address: A use.
City: I'w 7? ° r cc State:
IN
Zip Code: J,Z Fax:
Phone No. ! Sf— 65 u
g1 `o
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: 'Stiy Al E 36 S G
City: C)a kla� ?0q � state:
Zip Cod;T ¢ Fax:
Phone No.
E-Mail:
State or County License: Cu I
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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: 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 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
commencirmwork or recor your Notice of Commencement.
Signatulre of Owner/ Lessee/Contractor as Agent.for Owner
S' atu ont .License Holder
STATE OF FLORI A
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STATE OF FLORIDA
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COUNTY OF awa�
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COUNTY OF ru
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The forgoing instrume t was acknowledg fi�'rurgER i
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The forgoing instrumen wa acknowledged efor
DU U,e% o
this ID day of GiG dAi 20
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this-dayof 201
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Name of person making statement
Name of person making statement
Personally e� OR Produced Id tificatio�
Persona OR Produced Identificat n p
dentification�::* eo,
`.�'-
pe of Identif' ion
Produced :a:
Produced
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(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17