HomeMy WebLinkAboutBUILDING PERMIT APPLICATION71,
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
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Date: �• 1' Permit Number:
SCANNED)
Building Permit Application
MAR 5 201�
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
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Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FO
PROP®SED IMPROVEMENT LL7CAIle `
Address: id��" �`,� RI-1 & II
Legal Description T nAp I S L
rP lz 1,�,��" �dr� �G 2 2 0 t
Property Tax ID #: �� ! �/, AD �<-- 0 r7> — Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DE�SC*RIPTION OF WORK:
-
IN 4 I-D0 QI00
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CONSTRUCTION 11111 /�TION.
Additional work to be performed un er t is permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: 40 Sq. Ft. of First Floor:
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Cost of Construction: $ -) DO D Utilities: —Sewer _Septic Building Height:
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OWN I Ra LE-ES,II:
CONTRACTOR:
Name:
Named L lZt1��i
Address: ' 'i a'o ML,
Company:
City:. 9'20g/ State:PL,
Address:
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Zip Code: ` �Q°�/ Fax: `j
City: State:
Phone No. `7'7 a5t 1 I
Zip Code: Fax:
E-Mail: i Ri
Phone No
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above) I
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTI7N LIE lAW INFtJRMATION:
DESIGNER/ENGINEER: —Not Applicable _
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address: I
Address:
City: State;:
City:.' `'r ' State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not.Applicable
Name: i
Name:
Address: I
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 gr+ nting 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 plermit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Floridal 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 Noticelof 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.
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g a r of_ wn ./ see/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
-STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20_ by
(Name of person acknowledging)
i
(Name of person acknowledging)
(Signature of Notary Public- State of Florida) i
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification ;
Type of Identification
Produced
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW j
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
I
COMPLETED
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