HomeMy WebLinkAboutBUILDING PERMIT APPLICATION (2)All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _� • 1Q • % y. I Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: % 0
Legal Description:
Property Tax ID #:
Site Plan Name:
SCANNED
BY
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Buildin�9g Permit Application MAR 12 2018
Commercial
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2
Residential V--**'
— V 0-- 0 01 G f d r o—
_Mechanical _ Gas Tank _ Gas Piping, �. Shutters
Electric _ Plumbin _ Sprinklers a r: Generator
Total Sq. Ft of Construction: ®� Sq. Ft. of'First Floor:
Cost of Construction: $ '"C , c� S �� cry Utilities: Sewer _ Septic
Lot No.
Block No.
Windows/Doors"
Roof �� o�Pitch
Building Height:
Name W_�7 i M, 0 -tLvV pivA14 (,` Name:
Address: a 306 5Zk Company:
City: o S Le„ c, k State: "dL Address:
Zip Code: 4%H.9S! Fax: City: I State:
Phone No. "") ;j f a b 6269 Zip Code: Fax:
E-Mail: e 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.
WE I , 9NTAL Ca STRUCTI�N LIEN LAW ITT
NfORMATtON:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
_Name:
Address:
City: State:
City: State:
Zip: ,Phone
F F
Zip: Phone:
FEE SIMPLE; TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
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 w_oFkpr recording your Notice of Commencement.
9
ig�afiure o Owner Lessee/Contracto as Agent for 0
Signature of Contractor/License Holder Kf
STATE O FLORID
STATE OF FLORIDA
COUNTY OFiz-
- COUNTY OF
The fo,_,going instrument was acknowledged before m
�65m a :The forgoing instrument was acknowledged before me
this -V5- day ofMQ 1CC C P- 20J �y
EN;;
this day of 20_ by
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(Name of person acknowledging)
(Name of person acknowledging)
(Signature o otary Pub ic- State of FVbrida)
(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) tn,
.,6n
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
k`e'REVIEW
DATE
RECEIVED
DATE
COMPLETED
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