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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