HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: 89�NNED Permit Number:
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Building Permit Applicationo
Planning and Development Services MAY 22 T0J0
Building and Code Regulation Division P6rmittln
2300 Virginia Avenue, Fort Pierce FL 34982 Mont
Phone: Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential sr`�flly
PERMIT APPLICATION FOR:
°0kbPy0SE[31NPEWNT LOC ATIC3N
Legal Description:
Site Plan Name:
Project Name: _
HE
5
Lot No.
Block No.
oNSTRuCTI0N INOR(VIATION
itiona workto a per orme . under this permit— check a11 tat apply:
_Mechanical Gas Tank — Gas Piping `,-Shutters _ Windows/Doors
— Electric — Plumbing Sprinklers -Generator _Roof Pitch
aI Sq :Ft o"f_`C nst io'n •_; �co 7 / Sq. Ft."of First Floor:
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�t.ofConsfructio.n,.,_?5�%�- �c� Utilities: Sewer Septic Building Height:
-Name = Pt- 1
Name:
S
Company:
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Cite" State:
Address:
Zip Code.. T Fax:
City: State:
Phone No. /. �% �� -r (
Zip Code: Fax:
E-Mail'`^'r'M� LC
Phone No
F llM`Jee timple Title Holder on 44xt page ( if different
E-Mail
from the Owner listed above)
State or unty License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: i Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
`'MORTGAGE COMPANY: _ Not Applicable
.Name:
-Ad&bss:
City: State:
Zip: Phone:
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 with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit%suci � -
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 work or recording`,your Notice of Commencement.
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S' - tre>of Owrfee C6xifcactQas Agent7for.
Signature of Contractor/License Holder
s,
STATE OF FLORID
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STATE OF FLORIDA
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COUNTY OF '�' • LLAC.�- �
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COUNTY OF
The forgoing instrument was acknowledged before
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The forgoing instrument was acknowledged before me
this ay of 2Q by
2
this day of 20_ by
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V-,(ti(S S �,{ l F VL--�
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(Name of person acknowledging)
4....
, . •��
(Name of person acknowledging )
(Signature of N ry Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifica io
Type of Identification
Produced '
Produced
Commission No. (Seal) '
Commission Na. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
/
RECEIVED
DATE
COMPLETE
Rev. 7/2014