HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COM'rLcTED FOR APPLICATION TO BE ACCEPTED
`
Date: Permit Number:
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:
PR{OPO� ED INPR01/EMENT LOCATION:
Address: '� (7 i .wAv
Legal Description: �� G S �^ z� _'z9 �
Property Tax ID #: C� 'Z 0 ! 00/-1 49 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA LED DE�SC IPTI�O F OR
105SONSITIRUC ION INF®RMAT i
Additional work to be performed under this permit— check a t at apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
_ Electric _ Plumbing —Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities:"a _ Sewer —Septic Building Height:
OWNER/LP
1111170, TRACTOR:
Name _ -�D U A-F-!o C) F-
Name: �.
'6,:O?
Address: `5 z,! U $ W'� i r, �.
Company:
City: frs1L_r ):E)e_C State: L
Address:
Zip Code: Fax:
City: State:
Phone No.
Zip Code: Fax:
E-Mail:', 123f 6t 2 C y films
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.
DESIGNER/ENGINEER:
Name: Ji\- '
Address:
City: 1- ►2iY��5��`.
Zip: 33/6'�T Phoi
FEE SIMPLE TITLE HOLDER:
NotlApplicable
Not Applicable
Name: 0 W -W '-" JP- I
Address:
City: i
Zip: Phone: A
e
MORTGAGE COWANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: 0",
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 Noticelof 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
commencinia work.or recording vour Notice of Commencement. /%A
Signature of Owner/ Lessee/Contractor as Agentfor Owner
Signatur o Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �0e,- I
COUNTY OF
The forgoing instrum nt was acknowledged before me
The forgoing instrument was acknowledged before me
this S ay of i U&A 20_0 by ;
sl W.�l���►(l i
this day of , 20_ by
�i1
(Name of person acknowledging)
(Name of rson acknowledging)
1
(Sig tur of Notary Public -Sat of Florida)
( a of Notary Public- State8FIorida )
i
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification - A
Type of Identification
w
Produced'(�
Produced
^ ``
Commission No. (Seal) ° LASHAHNq IN
U * Notary Public
R on No. (Seal)
!F1o�rlda
• Stat
x My Comm.
of
11,, c Expires
REVIEWS
FRONT
rJ •�,.
�, OF F1.0�
it �nnu••`
ZONING-..=.—,-,-
ommission # F
0 �rlr
UP R1/IT 9 Rai
�%%?Q .:
Nota�
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
F�E�PEV1/ `
=Vt
REVIEWS
REVIEW
REVIEW
DATE
RECEIVED
DATE
i
COMPLETED
Rev. 7/2014