HomeMy WebLinkAboutBUILDING PERMIT APPLICATION- 111
All APPLICABLE INFO MUST BE COI['- ETED FOR APPLICATION TO BE ACCEPTLI,
Date:
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:
Legal Description:
Permit Number:
RECEIVED
FZ:B 0 5 2019
Building Permit Application
ST. LUCle County, Permitting
Commercial Residential
Property Tax ID#: I \�61_ 5543- a ba3- dd0 "3 Lot No.
Site Plan Name: n� Block No.
Project Name: IE/ /v a2i )e_4
Setbacks Front Back: Right Side: Left Side:
CrJIL�' �� � � � / �,JL✓�i�i�J
h�E2o/ + -
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_ Electric -Plumbing - _ Sprinklers _ Generator ✓ Roof 16-
0 P teh
ota o •onstr Sq. Ft. of First Floor: (`r66 o r-oT
Co of.ConstruUtilities: _Sewer _Septic Building Height. 1�
OWNER/LESSEE:
NONTRACTO
Name ;,
`Name:
Address: sr
Company:
r n
City State:
Zip Code: 3 Fax:
�^ c1
Phone NoZ&&
•--
Address:
City: State:_
Zip Code: Fax:
Phone No
E-Mail:
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.
SUPPLRMENTAL CONSA N I MWI INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
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. 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 concurrepcy review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to ano'thernonzresidential 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 our Notice of Commencement.
r
Signature of Owner/ Lessee/tractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLO
STATE OF FLORIDA
COUNTYOF
COUNTY OF
The fo going instru n as acknowledged before me
this T day f �, 20 by
The forgoing instrument was acknowledged before me
this day 20_ by
_ of .
Name of person making state ent.
Name of person making statement.
/
Potty Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identi ion
Type of Identification ,
Produced L
Produced`
(Signat re of go ary ublic-State of Florida
ture of Notary Public- State of Florida )
Commission No.
g ,, KAREN S. NIEL
o° °"$ a of Florida -Notary
EN
Peb fission No. (Seal)
`.i commission # GG 207484
My Commission Ex
ires
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