HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPL&ED FOR APPLICATION TO BE ACCEPTED
Date: �d' �' Permit Number: _
i ECEP" n—
DEC 1 hi 2CI
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 VVV
PERMIT APPLICATION FOR:
Address:
Legal Description:
.(4,,- mn i4 y _IS%a c oKY 1 LIfi%7 �&a
Property Tax ID #Af
Site Plan Name:
Project Name:a& Q iV0—r �cfr k
a
etbacks . Front Back: �'(_ Right Side: Left Side:_
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
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Lot No.
Block No.
windows/Doors^ ;
_Electric _ Plum i_Sprinklers _Generator _Roof Pitch
Total Sq., Ft of Construction: b Sq. Ft. of First Floor: E a �-
o a. v V,
Cost of Construction: $ Ah Utilities: --Sewer _Septic Building Height:
c�
Name
Addres =Gas 4c A Lie
City: Po L- ttc-i . State:
Zip Code: ?J2 Fax:
Phone No. 27 D
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
City: State:
—
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: =
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
'a
Name:
Address:
!
Address:
City:
City:
Zip: Phone:
I
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application's 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
rnmmenrinE work or recordine vour Notice of Commencement.
Signature o Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIPA
STATE OF FLORIDA
COUNTY OF .L1kClP_, I
COUNTY OF
The forgoing instrument was acknowledged before me I
The forgoing instrument was acknowledged before me
this 1441day. of 31per . 2011 by
I
this day of • . 20_ by
OVAghi& M . k!J;#.5
(Name of person acknowledging)
(Name of person acknowledging)
Notary Public-; State Florida )
(Signs ure of Notary Public- State of Florida) V
(Signature of of
Personally Known OR Produced Identification b\
Personally Known OR Produced Identification
Type of Identification a , ,
iType of Identification
.
Produced / 1 r
Produced
.I �a`, •••: CYNTHIA M. DEJESUS
Commission No. 1� 0 Q,a1 COMMISSION#FF071
Commission No. (Seal)
EXPIRES: March 19, 201
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,
REVIEWS
FRONT
ZONING
SUPERVISOR 9
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW.
DATE
RECEIVED
DATE
I
COMPLETED
ev. 7/2014