HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COIviirLETED FOR APPLICATION TO BE ACCEPTED;'--
Date: Permit Number:
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Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)J462-1578
PERMIT APPLICATION FOR:
Address: W
Legal Description:
Building Permit Application
Commercial Residential
� e . ..— �
Property Tax ID #: '�� —y% O(11� bcCLot No.
)—
Site Plan Name: Block No.
Project -Name: I AY
Setbacks Front Back: "_Right Side: L Side:
_Mechanical — Gas Tank _ Gas Piping —Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: WQ 4-r wAr*-044 Sq. Ft. of First Floor:
Cost of Construction: $ 10 5t�- 6e) Utilities: _ Sewer _ Septic.
If value of construction is 2500 or more, a RECORDED Notice of commencement is regwreu.
ti
Windows/Doors
Roof Pitch
Building Height:
DESIGNER/ENGINEER:
Name: &11k `5/w-r
Address: ' ,o S "T- s r
City: A-w 4-
Zip: Z Phone_
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:_
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Stater City: State:
I�7-.5- Zip: Phone:
_ Notl Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 Count 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 0 ,Hers 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.
11 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 inspectidD.4f
,Nou intend �,o obtain financing, consult with lender or an attorney before
commencinE work or re�vour Notice of Commencement. --% , • --?
SignaWe of Owe essee/Co,n..,rtractoras-Agent-for
Owner
fi ueCon cto "LI'cense Holder
All
n
STATE OF FLORIDA
STATE OF FLORIDA '
COUNTY OF
C1�
COUNTY OF
I
TheMring instr ment was acknow.11ledgeof
this 'day of 20 1 1 by
re me
The for,ggoing inst ment was acknowledged before me
this O�S day of 20 jJ by
owledging) I
(NK;z
(Name of person acknowledging)
i
(Si nature of Notary Public- Ate of Florida)
(Signature of Notary Public- Stat, of Florida )
I
Personally Known OR Produced IdentificationN
Personally Known OR Produced Identification
Type of Identific .r
Type of Identification
Jpk.
Produced �•� ASNAHi'!
a�: a, y Public -
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Produced
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Commission No. �° l° ,`�1 C :; a l)ilresDecr
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SUPERVISOR
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COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
-REVIEW
DATE
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RECEIVED
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DATE
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