HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR
11 APPLICATION TO BE ACCEPTED
Date: �� (g Permit Number:
SCANNED
BY
iu�leg pp County
Buis -din 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
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Commercial Residential �Y
Right Side
wits l I /Ve w 6(1 C-1 SvS&
Left Side:
Lot No.
Block No.
Additional work to be pertormed under this permit— check all tnat apply: u
_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: —Sewer —Septic Building Height:
@:W ER/1.E SEES
C�ONTRAC�TQR.
Name�d►A1.0 'f
Name
AddN4A S /
Corri'pany4
Cityw GI�tyfi7�� i i` Stater
Addr"ess'f NW S/�'✓h+�e oil- 243
Zip Code: 3 N 9 �'l Y Fax:
City: 4. f �q- 21je e , ll Stater
Phone No.e77Z ._37U — 0 35rZ
Zip Code: 3Lf c413 Fax:
E-Mail:
Phone No y72- 877 — / n 0
Fill in fee simple Title Holder on next page ( if different
E-Mail
State or County License
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
upP���� ��..o s�-�R�c�c1-ioN ���� �w �;N;
- � • Mr �- o ,
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
2-ip:- Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: i
City:
Zip: Phone:
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 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
commencing work or recording vour Notice of Commencement.
-Sigffature of Owner/ ssee%Contractor as Agent for Owner
STATE OF FLORIDA '
COUNTY OF
The forgoing instr ment was acknowledged before me
this day of 20R by
Name of perso making stat nt. /
Personally Known OR Produced Identification 11
Type of Identifation^
Produced�_'� �
(Signatureof N
,Si nature of ontractor/License Holder
STATE OF FLORID
COUNTY OF
The forgoing in str ent was acknowledged before me
thism
day of 20,f by
Name of person king state t.
Personally Known OR Produced Identification
Type of Id Y icatioj�
Produced_ O�
(Signature of Notary Public- Statk of Florida
Commission No.
g • p s
_* !
MY COMMI ,1,0M `# GG 04999{
EXPIRE 22,2021
Commission No.
'r'►'••.,,
,'tip"••`: •, 0 �N�QM'II44O�NE
d5V
.
Banded Thru Notary Pubk Undwabrs
MYCOMt�35t6tY#GG049998
March 22 2021
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