HomeMy WebLinkAboutBUILDING PERMIT APPLICATION°
All APPLICABLE INFO MUST BE COMPLETE D_ FOR APPLICATION TO BE ACCEPTED
SCANNED
BY
Building Permit Application
Planning and �evelopment Services
Building and C�de Regulation Division
2300 Virginia kenue, Fort Pierce FL 34982
Phone: (772)4162-1553 Fax: (772) 462-1578 Commercial Residential
[—PI—RMITAP'PLICATION FOR: tA F--\l 6�,s
Address: L1
Legal Description:
Property Tax |D
Site Plan Name:
Project Name:
Setbacks Fro
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Back: Right Side:
I aim WE
Left Side:
Lot No. —
Block No.
Additional under |znarappiy:
_Mechanic�l GasTank Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Root
� � Tota|S Ft f Construction: Sq. Ft. of ����
Cost ufCohstcuction: $ Utilities: rc Building Height:
City:
Fill in fee simpl�
from the Owneir
State:
Address: 70 1
Title Holder on next page if different
listed above)
E-Mail
State or County License
| ifvalue of construWon is 2500ormore, oRECORDED Notice of Commencement is required.
SUPPLEMENTAL C � N5T + T t�N LIKEN LAUV' IN�FOR� TI0 ,
DESIGNER/ENGINEER: _ Not Applicable.'MORTGAGE
Name:
Address:
COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Address:
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
before the first inspection. If you in to obtain financing, consult with lender or an attorney before
commencing_work or recording yg,6r otice of Commencement. /
Signature of Owner/ Agent/ L ssee/Contractor
Signature of Contra ctor/L' leHolder
STATE OF FLORIDA
COUNTY OF L
STATE OF FLORIDA
COUNTY OF 5�r, 1—y-�%R,
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 13 day of q p , 20by
this A3 day of A C i 1 205 by
cz�n c s pro Sd h vSdy1
(Name of person ack owledging)
(Name of person acknowledging )
.Poro\
(Signature of Notary P lic- State of FI ��6
(Signature of Notary P lic- State of Florida )
`F�o�`
a, �LPG\
Personally Known OR O'D'�Rt!� �14 f.
Personally Known, OR Produced I
Type of Identification Q��O�e`��`a\�°�a r.,;
Type of Identification Oda ��c'Se50e° geSS�
Produced �at� �`'. 5�°°�a"°°
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Produced �Q° ��o`� tP
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Commission No. -• ��ca eal)
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Commission No. .•,� Q5@°� r,
REVIEWS
FRZONING
VER
SUPERVISOR
PLANS
VEGETATION
URTLE
MANGROVE
COREVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014