HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETI' -'DR APPLICATION TO BE ACCEPTED - 4
Date: a Permit Number: K O oN Ss
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: SInC
PRQPOSED IN=PROVEMENT; LOCATION
Address:
Legal De cription: L� �/ G�/�, f �S G%
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Property Tax ID #: !j 1Ji3< ' S1d— o a— Od Lot No. _
Site Plan Name: Block No.
Project Name:
Setbacks Front c ack:L Right Side: Left Side:
CONSTRUCTION INFORMATION ,
Additionalworkto a pertormed under this permit - check _ all that apply:
_Mechanical _ Gas Tank —Gas Piping _ Shutters
_ Electric _ Plumbing _/Sprinklers _ Generator
Total Sq. Ft of Construction: -2,;,1Sq. Ft. of First Floor: _
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Cost of Construction: 5 &a� � - Utilities: —Sewer _Septic
_ Windows/Doors
Roof Pitch
Building Height:
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CON�TRACTOR::�.
Name 117
Address: w
Name:
Company:
Address:
City: Gz C Stat _
Zip Code: -5 % Fax:
City: State:
Phone No, % 2,)- 2 3 3 G �Z% %
Zip Code: Fax:
E-Mail: t°/I✓> /_ 9 •
Phone No
E-Mail
Fill in fee simple Title Holdidron next page ( if ifferent
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SU'PLEMENTAL }NS
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
_ Not Applicable
Name:
Name:
Address:
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Address:
City:
State:)
City:
State:
Zip: Phone
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Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY:
Not Applicable
Name:
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Name:
Address:
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Address:
City:
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City:
Zip: Phone:
Zip: Phone: I
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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 g janting 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 intendlto obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
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Signatur ner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLOR DA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledge_Jbefore me
The forgoing instrument was acknowledged before me
this °� day of SA-f . 20� by
this day of , 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Pu ic- State of Floi ida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification I
pe of Identification
Produced �- pLpNNAMARIEGIVENS
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my COMMISSION
16,2020
Commission No. —� _ :*' AARE&: camher dare
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