HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE Ci MPLETED FOR APPLICATION TO BE ACCEPT s._/_
Date: OWNED Permit Number:
M Luce, Coup, r�V
Aft
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:
P.RaPOSEQ IN:PRO1/EI1/IEIUT LtJCATION
Address:
Legal Des
Property Tax ID #: J31 Q 6&0 0-oy 000 0 Lot No._
Site Plan Name: _ Sr+ Block No.
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
CQNSTR,UCTICiNxINFORMATIO.N
a ,a
Additional work to be performed under this
permit- check
all that apply:
a..
_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:
Name Name:
Address: 5to, 4a- --b6
t
City: -f-4 P,e rceP/ State: 'Adtlress: - _
Zip Code: cis 1 Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: e4, jl� . Co Phone No
Fill in fee siniple 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.
SUP "L.k� ENTAL C?I STRCICT 41 llF AIN t R A "[QIN: ,
DESIGNER/ ENGINEER: Not Applicable E COMPANY: Not Applicable
_
Name: Name:. _ ... :.
Address: I Address: `•
City: (State: City: State:
Zip: Phone I Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I
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 thatlis 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 covenant's 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 Noticce 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 qpfe pordingour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent
for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF (_
COUNTY OF
The forgoing instreTmt was acknowledged before
me
The forgoing instrument was acknowledged before me
this _!7 day of 201119 by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
(Signatu/,ef Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known ✓ OR.Produced Identification
Personally Known OR Produced Identification
Type of Identification
St�SAN.L
WALKER
pe of Identification
Produced;'"r'°!<¢,
+ • MY COMA
IfNI9810N #�FF18
201
oduced
3
Commission No.�' ,��
December 18,
mmission No. (Seal)
407 399-0ta3 ori
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