HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONi
All APPLICABLE INFO MUST BE COMPLa: FOR APPLICATION. TO BE ACCEPTED
Date: is - Jo- l� Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
t . 'DEC'2 U
Building PermitAn n'lication Pe °
pp arm, Da9artmsnt
St, Lucie County
Commercial Residential
' lYiElr,
Legal Description: SCANNFn
BY
a uounty
Property Tax ID #: LUt No.
Site Plan Name:
Project Name: C ce t4
Setbacks Front 7 , Back:
P]
Right Side: f 1) -, LeftSide: 10,
Block No.
W !d• - N dA.0
✓Mechanical _GGasTank _Gas Piping _Shutters —Windows/Doors
(Electric ✓Plu'm1bing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: U Sq. Ft. of First Floor: k
Cost of Construction: $ Utilities: —Sewer V5eptic Building Height:
OWNER/LESSEE:
reONIT, ECTOR:
Name Gt
Name:
—,
Address: 5•
Company: w
s
City: !V4. ErrC State:
Zip Code '32 1�Fax:
Phone No. ,s
Address:+'
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City:
Zip Code:
Phone No
—'z rSEete:_
Fax:
E-Mail:
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL OWNST
ION LIEN W INFORMATION:
DESIGNER
Name:
ENGINEER:
D
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
r
. &- JQ
r.
Address:,
City:
Zip:
k1ce
Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not Applicable
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. Lucle 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 Associatiod rules,,bylaws orand,covenants.that may,"restrict'or prohibit such
structure.'Please consult with your Home Owners Association and review your deed foVany 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 Commencemert must be recorded.andlposted on the jobsite
before the first jigNaeqion. If you intend I:o obtain financing; consult with lender dramattbrney before
commencing rk or,recording your Notice of Commencement. r •
I
natur Owner/,Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder C -
4. .a. lu ♦ .. 1 tv a
i i S ..lC i-\ ,.•l •� r -_ 1.. _y `-''\'. •,i:.
STATE,OF. FLORID
STATE FLORIDA •:,
r hISZ ' : ."' °
-OF
OF >:.
COUNTY OF ut
COUNTY
The forgoing instrument was acknowledged before me
'the forgoing instrument was acknowledged before me
this _00 day of Q 20 Irby
this _ day of • 20_ by
Name of peF§on making statement.
Name of person making statement. -
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification
Type of Identification
.Produced F C p L
Produced
/%
(Signature of Notary Public -State of Florida I
(Signature of Notary Public- State of Florida I
Commission eliln, El EN VA
°kState
Commission,Nol. `` "T (Seat)' !
9i° of Florida -Notary Public
: -lt 1, ` .;j-'.! �,..; •! t- , �,.•!<, I - .., y. `,' '
_' 'e Commission H GG-270079
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DATE
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