HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONDate: I �� r 't' �Permit Numb-
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Bui ing. Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FC 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential .
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: j.� `3"[ ( -I® C) 3 7 C)0 0
Site Plan Name:
Project Name: I
Setbacks Front Back: I. Right Side:: Left Side;
3
Lot No.
Block -No... -
Additional work to be performed uncle r tnis permit - cnecK all tnat apply:
Mechanical _ Gas Tank ,i _ Gas Piping _ Shutters _ Windows/Doors
' Electric. _Vp�_lumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction: _. Sq. Ft. of First Floor:
Cost of Construction: $�%.� �I� Utilities: Sewer _Septic Building Height:
.. n
Name' 'C- OfLL n.C,> Name: rr, nn cc
Address �- Company: IC.�Jl:/� r✓L C
City:-e�G State: •, R- Address: , 0. 60
�� - �-2u�:�-J� �
Zip Code: Fax: City: L_ State:
Phone NO. "L 73Zip Code: ��— Fax:
E-Mail: 1 d ( � ' Phone No.))a-
Fill in fee simple Title Holder on next p ge (if different E-Mail: SD L
from the Owner listed above) State or County License: t�. fir!
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
EER:
Name:
Address:
City: _ State: -
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MUK1.csAbrC0MPANY:. _ Not Applicable
'Name:
Address -
City: State:
Zip:.. Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is -here made to obtain a permit to do the work and installation as indicated.
l certify that no.work or installation has_ commenced prior to tlieassuance 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
commencinR work or recording vour Notice of_fammenrempnt i
ON/-
Signature- ner/ /�g�ntl Lessee an—atur ont[acfor/L se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -_� k, L o COUNTY OF S t, L Jr- i
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of . dJQ.r ` Z0 by thisay of . '6 e c : 04 by .
(Name of person acknowledging) (Name of person acknowledging) -
(Signature of Notary Pu ' - State of Florida) (Signature of Notary Pub " - State of Florida )
Personally Known ORS r gptlfi'cASNs r,da Personally Known OR Produce if`isatio
Type of Identification d, .' k` Stated-Vai Type.of Identificatio dt : ��pIAIA GIVEN
r �tPRV P , My comet. ExPrro�D # EE g58T61 haY'Poe ., Notary Public • a 2016
Commission No. 1;3. c6 t�iot, tNotary pssn. Commission No. :'$° com �(f s Dec ls,
h NaCioria
P ' gondedShrou9 • � My Commission # EE 85876Assn.
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''�;F �F F,,�,, Bonded Through National Notary
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