HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED
Date:
APPLICATION TO BE ACCEPTED
Permit Number:
ilding Permit Application °e � �nQ `��zers
Planning and Development Services
Building and Code Regulation Division �O�rl�y o4t
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential A`
PERMIT APPLICATION FOR: 4rrp
PROPOSED lNPROVEN[ENT LQCATI N _
Address: r S e—
Legal Description:.,
—r)41Ck., ( ` (rS/ 32 -; r�
CONSTRUCT -ION INFORMATION
�. _ _ ,.r .�.M_
Additionalwork to be per or ed under this permit — CheCK all that apply:
_Mechanical _ Gas Tank _ Gas Pipiing _ Shutters _ Windows/Doors
_ Electric _ Plumbin/g Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction: ,��f�yc Sq. Ft. of First Floor:
Cost of Construction: $ a &I e2 utili lies: _ Sewer _ Septic Building Height:
I If
OWNER/LESSEE :; �:
CONTRACTOR::.
Named x �`g 44- 4.1z!!�4 5- I
Name:
Address: ° 4z® ��3'
Company:
Address:
City: `� State: G
City: State:
Zip Code: i� Fax:
Phone No._®S ��_ �,/ -?42 '
Zip Code: Fax:
E-Mail:
Phone No
E-Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License .
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRIJCTIC?N C1EN LAW INFORMATION U
DESIGNt/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name: " .
Address��`' ``
City: Stater" ,
. Name:
Address:
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 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 vour Notice of Commencement.
u
atbifEWZcaner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
r� ��
STATE FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this .2J day of LAL4 20 lg by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging )
1
S
(Signature of Notary Public- State of Florida)
ignature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Iden ifi tion\
T e of Identification
Produced +� .•'' YP:B••, DAWN MILONE
duced
=,N ;* MY COMMISSION # GO 04999
Commission No. I$(PIRES:March22,2021
'
C mmission No. (Seal)
,�,rt l�•' on a hru Notary Public Underwrit
rs
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014