HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE
Date:
TED FOR APPLICATION TO BE ACCEPT qq
Permit Number:
ANNtw
BY
(Est:
Buil ing 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 COmmerClal Residential V
PERMIT APPLICATION FOR:
Address:
Legal Description:
PropertyTaxlD#: 37Q�.f'0��•(n`�� �1�3
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Left Side:
Additional work to be pertormed under this permit— Check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic
Lot No.
Block No.
EW`
60�windows/Doors
Roof Pitch
Building Height:
Address:
Legal Description:
PropertyTaxlD#: 37Q�.f'0��•(n`�� �1�3
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Left Side:
Additional work to be pertormed under this permit— Check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer —Septic
Lot No.
Block No.
EW`
60�windows/Doors
Roof Pitch
Building Height:
DOWNER/LESSEE :, �'
.
CONTRACTC�3R:
Name l.Sau,sV_-
Name:
,Cbmpany:
Address: &/Me7Y4 bK
City: For* 6er.c State:[
Address:
Zip Code:3y982 Fax:
Phone No. 77A al4 4i.? %
E-Mail: AA' 'e Plyr JT P 6-4 C&A(
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice
of Commencement is required.
L �I1�ENTAL eQNSTR�
�TI�N '�N LA
FO AMA i'ON:
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:
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 us'e's 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 or recording our Notice of Commencement.
Signature wner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OFF
COUNTY OF
The fo,Toing instrument was acknowledgedbefore me
i�Q�
The forgoing instrument was acknowledged before me
this L day of , 20by
this day of . 20_ by
(Name of person acknowledging)
(Name of person acknowledging )
(' atu a of Notary Public- Stat of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identificatiori_--�'
Personally Known OR Produced Identification
Type of Identificati
��-
Type of Identification
Produced
Produced
Commission No. "(Seal) AINIMtiR
om fission No. (Seal)
Notary Public State of
Florida
n 9n9R •
REVIEWS
FRONT
7N,
C�q� mission # FF 177249
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REVIEW
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REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014