HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 9, 2 1p , st✓q� Permit Number: `
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Building Permit App ication
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 X—
PERMIT APPLICATION FOR: To Select from dropbox, click here
Address: 2-60 .56 &s%/,4 L27—
Legal Description:
PropertyTax ID #: Lot No.---3 1_
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be nertormed under this permit —check all apply:
�HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric ❑Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: as
$ �� Utilities, - In Building Height:_
Name —7—A
Address: Xa S;� C7`
City: State: �L.
Zip Code: Fax:
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address:
Zip Code: _
Phone No.
E-Mair. 3
State or County License: t�-74f
If value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
'PP.�LEMENT�AL G®.N -TRMJC'T ONLIEtV l./�11V INORI�tI/�i10N:
DESIGNER/ENGINEER:
_Not Applicable
MORTGAGE COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ 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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of Owner/ Agent/ Lessee
STATE OF FLORID
COUNTY OF
The f�{a�pping instru ent w acknowled ed before me
this o�l�iay of .> 210 by
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(Name OT person acknowledging)
1
(Signs ure of Notary Public- Stake of Florida) /
Personally Known OR
Type of Identification Produced
Commission No.
Revised 07/15/2014
Identification
Signature of Contractor/License Folder
STATE OF FLORIDA
COUNTY OF ST W crg�'
The forgoing instru ent s acknowledged b fore me
this day of t 20 (by
N Ci�_bta. -
(Name of person acknowle gang
i
(Signature of Notary Public- State of Flo ida )
Notary Public - State of F on
�41)Comm. Expires Mar 22 �
Commission # EE 877171
finally Known OR
of identification ProduNe
.1✓
.` DAWN MILONE
n No: �=°t �`�': i� Public - State of Flori
�iy Comm. Expires Mar 22, 21
Commission # EE 877571
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