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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APP ICABLE INFO MUST BE COMPLEYevi FOR APPLICATION TO BE ACCEPTED
Date: I
! o � ®o�s
�GANNED Permit Number:
2�, 5 i. 0, BY
$t
Building Permit Application
Plannin and Development Services
Building and Code Regulation Division
2300 vi pinia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMjJT APPLICATION FOR:
Address: lj1,� 01' (1 A
Legal Description: v
N V:
Property ax ID #:-�©~
Site Plan ame:
Project N ` e: CQ Y
Setbacks Front Back: I 1 Right Side: Left Side:
MUUMUIldl�lAtorKTODepertormed un er t is permit - c ec a t at app y:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ ElecJic . _ Plumbing _ Sprinklers Generator
Total Sq. Ft I f Construction:
Cost of Consttruction: $
Sq. Ft. of First Floor: —
Utilities: —Sewer — Septic
""""
" Y
Nam e:
Address:
Company:
State:
City: ci
Address:_
Zip Code:p1m
Fax:
City:
Phone No.�
75-. 8393
Zip Code:.
E-Mail: (I
Phone No
l ple Title Holder on next page ( if different
Fill in fee si
E-Mail_
from the 0,
ner listed above)
State or Q
License
W
Lot No.
Block No.
Windows/Doors
_ Roof Pitch
Building Height:
State:
,value of co4truction is 2500 or more, a RECORDED Notice of Comm�Cement is required.
� �
Not Applicable MORTGAGE COMPANY: Not Applicable
DESIGNER/ENGINEER:
_
Name: -
Name:
Address:
Address:
City:
City:State:
State: Zi-_ phone:
Zip: Phone
Not Applicable BONDING COMPANY: Not Applicable
FEE SIMPLE TITLE HOLDER:
_
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
--
OWNER/ CONTRACTOR AFFIDVIT: Application is
here the de to obtain of a permit.s mit to do the work and installation as indicated.
I certify that no work or installation has commenced pp
St. Lucie County makes no representation
Owners granting
permit will
esabylaws or 8nd covenants that mayldrestrictborpstructure
oh b such
which is in conflict with any app
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
Inconsideration of the grantingoff pthis lans,
Florida da Building Codes aermit, I do nd Ste Luce Coue that I inity Amendments.
in the work
in accordance with the approvedN
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
imming pools, fences; walls, signs, screen rooms and'accessory-uses to another non-residential user
accessory structures, sw
WARNING TO OWNER: Your failure to Record a Notice of Commencement t
must be recorded and posted oin your n the twice
ment m thejobsite
improvements to your property. A Notice of Commence
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before, I'
commencin wor rec rdin our Notice of Commencement.
Signature of O ner//Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA1 STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru nt was acknowledged efore me The forgoing instrument was acknowledged before m
20by this day of , 20_ by
this day of
(Name of person acknowledging)
r
(Name of p rson acknowle ging )
(Signature of Notary Public- State of Florida )
Perso I Ilut t5'�iy�rn LASOR,4Y.ed6QBA Iden ication
Type ` tpniotary Public - State of Florida
Prod
My Comm. Expires Dec 20, 2018
o�; �omrnissiuu rr i r i c 9
OF V Bonded through National Notary ssn
Corn on lt!
REVIEWS FRONT �CO NTER I ZONING REVIEW I SUPERVISOR REVIEW
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary Public- State ofTlorida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No. (Seal)
it
PLANS VEGETATION SEATURTLfEi! MANGROVE
REVIEW REVIEW REVIEW t I. .I REVIEW