HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETw'r`OR APPLICATION TO BE ACCEPTED p q
Date: 1a "t 1 Permit Number: 11 1a'
3
DEC 18 2011
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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
PERMIT APPLICATION FOR:
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Address:
Legal Description:
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Property Tax ID#: a3ddt-3y1— 0'C>G
Site Plan Name:
Proiect Name:
Setbacks Front Back: Right Side:
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Left Side:
Residential
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Aociltlonal worK to ne pertormeo unaer tnls permit — cnecK all tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: � IZoU Sq. Ft. of First Floor:
Cost of Construction: $ (i o Q Q 0 Utilities: _ Sewer _ Septic
Lot No.
Block No.
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IL
_ Windows/Doors—
Roof "b -) Z Pitch
Building Height:
Name 'M Y V l 1! UL&V W Name:
Address: Uj(I 0 a Company:
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City: L��C`� State: _ Address:
Zip Code: Fax: City: State:
Phone N —7-) - — l Zip Code: Fax:
E-Mail: dQ ,cony 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.
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SPR�ti"ACsaNSTR!lCTiMCI { iN4RM1TiQ1:
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DESIGNER/ENGINEER: ` _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address:
City: State:
City: State:
Zip: Phone
I
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: I City:
Zip: Phone: I Zip: Phone:
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OWNER/ CONTRACTOR AFFIDVIT: AppJIication 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
is Owners
which in conflict with any applicable Home Association rules, bylaws-br 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 No ice 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 our Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent.for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA�A �
COUNTY OF uc i �FLORIDA
OUNTY OF
The forgoing instrument was acknowledged before me
V% by
The forgoing instrument was acknowledged_ before me
day
this day of 201
this of : 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Nota ublic- State of Florida
(Signature of Notary Public- State of. Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L L— GNENS
Produced
DEN 022023Mp
Commission No. ±c '• �' MYCDMtJII SION berG6 2p20
Commission No.'' (Seal)
s �(PIRES: PublIGUnderwnters
edihruNotary
•FOF Fes•.
REVIEWS
FRONT.
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW,
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ke—v.7/2014
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