HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTw'
Date: � ' Permit Number:
SCANNED
BY
Bufldn:m Ynit Application
Planning and Development Services I
I
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1I578 Commercial Residential
PERMIT APPLICATION FOR:
Address: Az0 00 0
Legal Description:
'Property Tax ID #: / 7!(/ • uCJp1.
Site Plan Name:
Project Name:
Setbacks Front Back:
uARRI
Right Side: Left Side:
Lot No.
Block No.
Additional worK to be pertormeci uncler this permit— cnecK all that apply:
_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: $ 19
QO Utilities: _ Sewer _Septic Building Height:
OWNER/LE-S&EE:
G• NTRACTt?R:
,Name Co I'
Name:
Company:'--"
Address:ao2.21C In 5- U
City�a / i State�L
Address:
Zip Code:C��%q Fax::
City: State:
''//
Phone No. 602— �(O`7�' 7�/
Zip Code: Fax:
Phone No
E-Mail:
Fill in fee simple Title Holder on next page (I if different
E-Mail
State or County License
from the Owner listed above)
I
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPP�E!'�IE�N Ai CONSTR
CTION Li�N LAW { `
0 M T�CiN:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
-Name:
Name.
Address:
!
Address:
City:
State:
City: State:
Zip: Phone
!
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
I
City:
Zip: Phone:
Zip: Phone: I
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 co�menced 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 con currency 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_- recording your,' Notice of Commencement.
Signature of Owner/ Les ee/Contractor as Agent for Owner
Signature of Contractor/License Holder
i
STATE OF FLORIDA !
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledge,Q before me
The forgoing instrument was acknowledged before me
this 3 day ofD� 20A by
i
this day of 20_ by
(Name of person acknowledging) 0
4(Siature
(Name of person acknowledging )
of Notary Public- Statb of Florida)
(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. ,.�� ����,, LAgSee'1)a INGRAM
Commission No. (Seal)
Plotary Public - State of Florida
h!•E My Corn;n. r ;'res Dec 20, 201�
Corl r�jS'
It FF 11. L ,J '(
REVIEWS
FIiONfT'I
__ -
ZONING
SUPS;RV7SOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
C '
UNTEW-`
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.