HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COhiri.rTED FOR APPLICATION TO BE ACCEPTEb ( �
Date: Permit Number: 1
Building Permit Application
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:oa 1 a r
Address
Legal Description:
M
Property Tax ID #: a3 a$ y y^ �Od �- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical . _ Gas Tank _ Gas Piping _ Shutters I _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $���
r-;
_ Generator _ Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name 7-4ePO-4 t5re4\'SWPM-3
Name:—
Address.-7 P-L .
Company:
City: State-
Address:_
Zip Code: a3gq Fax:
City:
Phone Now-C)-
Zip Code:.
E-Mail: --S I CO(`C\
Phone N
Fill in fee simple Title Holder on next page ( if different
E-MaiT
from the Owner listed above)
or County License
Fax:
State:
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not
Name:_
Address:
City:
Zip:
Phone
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
e MORTGAGE COMPANY: _ Not Applicable
_ Name:
_ Address:
City: State:
Zip: Phone:
_ Not Applicable
OWNER/ CONTRACTOR AFFIDVIT: Applica'
I certify that no work or installation has comrrieni
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
is hereby made to obtain a permit to do the work and installation as indicated.
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 uilding 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 Rec4d 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
commencing work or recording your Notice of Commencement.
Signature o wn / Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder '
STATE OF FLOR IA
S� L.`lc R,
STATE OF FLORIDA
COUNTY OF •
COUNTY OF
The forgoing instru ent was acknowledged before me
The forgoing instrument was acknowledged before me
this day of O-1 20jJ by
this day of 20_ by
S�t0.cy �tanSGdW�,b
(Name of per -son acknowledging)
(Name of person acknowledging)
(Signature of Notary P lic- State of Florida) I
(Signature of Notary. Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced V L
Produced
-t , p Np%RIEGIVENS
Commission No. s) ' °` % M�S�1 IISSION#00022023
Commission No. (Seal)
�= EXPIRE�:December16,2020
yik; Q: Pubilc Underwrller'
F& Bond NotaN
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FRONT
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SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW.
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED