HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE —INFO MUST BE COMPLETLL, r-JR APPLI
'Date,: r%,
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772).462-1578
Address:
Legal Description:
,TION TO BE ACCEPTED
NNED Permit Number: �� ��
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Property Tax ID#:
Site Plan Name: —
Project Name:gV tG�i
Setbacks Front Back: Right Si
Permit Application MAR.
,rcial Residential
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing —Sprinklers _ Generator
Total Sq. Ft of Construction: OoD I Sq. Ft. of First Floor: _
Cost of Construction: $ AIQW, Ol3 Utilities: _ Sewer _ Septic
Name m. I
Address:
City: k`� State:` '1i1
Zip Code: ,3QQb _Z— Fax: !
Phone No. 777 W4 7. -7S !
E-Mail:
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot NG-V
Block No�__
Windows/Doors
Building Height: It
Name:
Company:
Addre _s:
City: State,�Ttf
Zip Co,e: 3`iq, Fax:s�03V1
Phone `
E-Mail4m% V�
State or County License (fZ COS%_
f value of construction is 2500 or more, a RECORDED Notice of i
mencement is regLkred.
SU PL MENfi L CtJ STR
�7'ICiN LIEN LA+UV
NFO MATIQ
DESIGNER/ENGINEER:'-
-Name:
Address:
Not Applicable
I
MORTGAGE COMPANY: - °� of A-icable
N ppl
Name
Address:
City:
Zip: Phone
-
State:
f
I
City: State:
Zip: • Phone:
FEE'SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
of Applicable
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 withany applicable Home Owners Association rules, bylaws. or and covenants that=may'restrict o.r prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the grantingof this regLsted permit; `I do�hereby agree that 1 will, in alrrespects; perform the work
in accordance with the approved plans, thelFlorida 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`ano`the'r 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�your Notice of Commencement. /
Signature o caner/ Less ee/Contractor,as Agent for Owner -
'Signatur o Contractor/License.Holder .. :.,
STATE OF FLORIDA J .. •:
Ly
' STATE OF FLORIDA. -
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COUNTY OF S'E' CA e
COUNTY Cif,
Thej.5rgNng instru was a knowledg fore me
thisdayof 20r
The g instr ppent ws accknowledgg efore me
thisay
of20y
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Name of person jaking statement.
Name of pe n making statement.
Personally Known OR Produced, Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced L- $L,
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Produced L 1D
(Signature of Notary Pu ' - State of Florida) 'DNS.
(Signature of Notary Pub ic- S
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Commission No. '��1C0 S N C16.2p2� �eF
NpM�R #�G022023
Commission S�\S�d O tee
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