HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MU BE COMPLY 1 FOR APPLICATION TO BE ACCEPTED
Date: �l
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:
Iso�-0395
Building Permit Application' SCANNED
By
St. Lucie County
Commercial Residential
C" L
Property Tax ID #: 34 b O i slo— /00 ' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
k
i j I (
0
_Mechanical _ Gas Tank Shutters _ Windows/Doors
_ Gas Piping _
V Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 9
0 0 ' Ct e Utilities: _ Sewer _ Septic
Roof
Building Height: -
Addrew_366V /,1-�DWP - VD- Company:.� - , n K,C4C — wc. �c"ct.11L41,
City: Fj -- Pz R C�: GC. State: L'' Addres'SA D S` W , $-75
Zip Code,3gq$Z Fax: City:ForrP:'CRGE Stater
Phone No:'i I.7 2-" G 1- a 7-? ' = Zip Code; 3Yft tt t" Fax:
E-Mail:: Phone No
1�' %3
Fill in fee simple Title Holder on next page•(if diffe`rent'' . E-Mail ¢•on I l , ao #9
from the Owner listed above) State or Coun License MROIMI
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
e
DESIGNER/ENGINEER: �NotApplicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
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 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
befor he first inspection. If you intend to obtain financing, c9nsult with lender or an attorney before
cornmenting work or recording our Notice of Commencer t.
Signature of Owner/ Lessee/Agent
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORID/
COUNTY OF LJ�'"
COUNTY OF At1i1 &=,�
The fo gl ng ins ment as acknowledged fore me
this 20 A by
The for oing in men as acknowledged b fore me
this day of 20 by
(Nam f
(Name of acknowledging
person
n`
person acknowledging) _
_ C 1 W ANN
(SigrI of Notary Public -State of Florida) " /
(SignatutI ♦ta
Public -State of Florida )
Personally Known OR Produced Identification
Personall(%yy�
OR Produced Identification
Type of Identification " L_b L/
Produced
Type of eePtrtiyati
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—�
Produced
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Commission No. , ^%6�;, (sealgAwN MILONE
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Notary public - Stale or Florida
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DATE
RECEIVED
Y.W
DATE
COMPLETED
ev. 7/2014