HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABL INFO UST BE COM�rf.elED FOR -APPLICATION TO BE ACCEPTEDN
Date: 3 Permit Number:
- -- -- - Building Permit plication�'
Planning and Development Services SCANNED
Building and Code Regulation Division BY
2300 Virginia Avenue, Fort Pierce FL 34982 l St. Lucie County
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
ENT
Address: /
Legal Description: 31( 1 Y—
f
I IUN: -
l
- 62 1p -coda 9'
Property Tax ID #: Lot No.
Site Plan Name: [a:z Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
CONSTRUCTION INFORMATION:'
_Mechanical _ Gas Tank _ Gas Piping _Shutters
_ Electric _ Plumbing �� � Sprinklers _ Generator
Total Sq. Ft of Construction: z 'rS' ,WSq. Ft. of First Floor: _
Cost of Construction: �— �6L�� Utilities: —Sewer —Septic
Windows/Doors
Roof
Building Height:
,OWNER/LESSEE- ..
CONTRACTOR:
Name o /' t
Name: c
Address: 16tfl 5 OW
Company: p('&jig AM
City: 5* t r L. State
Zip Code: 3rfQ�iL Fax:
Phone No. 72 Z °
E-Mail: T WIN
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Address: G 2 c
City: L o - Stater
Zip Code: 3 t6i E > Fax:
Phone No 2
E-Mail �('c rYliro,.4 3 v 7yn ,��
State or County License .7— 3i
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
_ Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
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 posfed-on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Agent '
Signature of Contractor/License Holder ,
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _ day of , 20_ by
this_ day of 20 by
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public -State of Florida)
(Signature of Notary Public -State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
Commission No. (Seal),
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION..
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014
All APPLICABLE INFO MUST BE COMPLz -'J FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PROPOSED,IN,PROVEMENTtCECAION
Address:
Legal Description:
Property Tax ID #:
Site Plan Name: _
Project Name:
Setbacks Font
Back: Right Side: Left Side:
_Mechanical _Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_Gas Piping _Shutters
_Sprinklers _Generator
Sq. Ft. of First Floor:
k
Utilities: ' Sewer _Septic
Lot No.
Block No.
��
Windows/Doors
Roof
Building Height:
OtIUNRLE-SSEE
CONTRAS R:.
Name
Name:
Address:
Company:
City: State: _
Zip Code: Fax:
Phone No.
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.
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
is in
which 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 jobsit
before the first inspection. If you intend to obtai Inancing, consult with lender or an at ey befor
commencingwork or recordingo otce o ommencement.
F
"DESIGNER/ENGINEER:Not
Name:
Applicable
MORTGAGE COMPANY:Not
Name:
Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:Not
Name:
Applicable
BONDINGCOMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
_Z� 7� ZSignatureo
Ll
Ub
ov
6
r/Lessee/ontracoAgentforOwnerSignatureoCtractoicenseHoler
STATE OF FLORIDASTATE OF FLORIDACOUNTY OFCOUNTY OFTheoroininstrumwasnowledabeforemeThefininstrumtwasacknowledPPebeforeme
this�dayof20�bythisdayof�201�by
(Nameofpersonacknowledging)(Nameofpersonacknowledging)
gotaPublic-StateofFlorida)Sialic-StateofFloridarnANtifica'ersor�ownRProducedIdentification
TymissSteIlo�''%.PrCoPmExpiresaY270mmvFf�err0aCommissioNatfoealeal)"f(Seal)
�oa1Naryq�^9REVIEWSFRONTZONINGSUPERVISORPLANSVEGETATIONSEATURTLEMANGROVE
COUNTERREVIEWREVIEWRREVIEWREVIEWREVIEW
EEIVED
EMPLETED