HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COI ri'iTED FOR APPLICATION TO BE ACCEPTE'ii
Date: l' 1 1 Permit Number:
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Building Permit Application AUG 9 1 1ni7
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
Address
j Legal Description:
PERIMTTING
St. Lucie County, FL
Residential „)C
Property Tax ID #: l Lot No.
f Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_ Right Side: Left Side:
_Mechanical _ Gas Tank —Gas Piping _ Shutters '. s_'Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construc ion:
a
Cost of Construction:($ 3�
Generator Roof Pitch
Sq. Ft. of First Floor: !'
Utilities: Sewer _Septic Building Height:
OW IMMO �S�SE 1 1
K@NTRACTO�R:
Name /*
Name:
Address Ittmz
Company:
City: 25i" 6mi P� State:
Address:
Zip Code: / Fax:
City: State:
/
Phone No. p�c�� %t"� 9� 7�RAK 774 7
-�
Zip Code: Fax:
,
E-Mail: 62A�/1% i?C ( &&e&e ,, _
Phone No
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.
SUPPLEMENTAL MMUMMM * LIEN LAW INF®RMA
M;
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ IVot Applicable
Name:
Name: •
Address:
Address:
City: State:
Zip: Phone
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
commencine work or recording vour Notice of Commencement.
Signatu.r Owner/ Less Agent for Owner
Signature of Contractor/License Holder
of ee/Contracto as
STATE OF FLORIDA L' I
STATE OF FLORIDA
COUNTY OF"�#'.
COUNTY OF
The for oing inst ment was acknowledged efore me
this day 20_by
The forgoing instrument was acknowledged before me'
this day of 20_ by
of
1
,
(NaVolper�,_n acknowle g)
'41��.
(Name of person acknowledging)
(Signat re o N tart'' blic- S a e ; Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati
Type of Identification
Produced
Produced
Commission No. r I) KAREN S. NIELSEprn
;G Commission ;#
' sion'No. (Seal)
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4F My Commission E
OF it
5637
Ores
REVIEWS
FRONT
1
ZONING
SUPERVISOR
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW,
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/ZU14