HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMI,, _ID FOR APPLICATION TO BE ACCEPTEDL-�
Date: Permit Number: VU —0 3 `✓
SCANNED
BY
St..L"Pie C nt
Building rehnit 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
PERMIT APPLICATION FOR:
Residential
Property Tax ID #: !�M• c ko--7 C" M,s Lot No,
Site Plan Name: Block No.�
Project Name: 1 e rff ?y-1 1 Cam •
Setbacks Front Back: Right Side: Left Side:
Addal worK to be perrormea unaer tnis permit- cnecK an tnat apply: iti7Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Z
Cost of Construction: $ SO
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic
Windows/Doors
Roof
Building Height:
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Company:
City: tccf State:
Address: 1 V,1k n ckC
Zip Coder Z— Fax:
77
City: < L� Stater
Phone No. SZN -1 "[ a - �S SLi
Zip Code: Sqo Fax:
E-Mail:
Phone No.�M?
E-Mail: a
Fill in fee simple Title Holder on next page (if different
State or County License:
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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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, 1 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 your Notice of Commencement.
Signature of Owner/ Agent/ Lessee
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
REVIEWS
DATE
RECEIVED
DATE
COMPLETED
(Seal)
Contractor/License Holder
STATE OF FLRIA pp
COUNTY OF , , Ls, I C
The forgoing instr ment was acknowledged before me
this %� day of % 20I%\- t by
me of person ck owledging )
%(Signatur,Vof Notary Public- State of Florida )
Personally Known �OR Produced Identification
Type of Identification Produce
I' ; o�PayP�A('•. JERALYNNE RUSSELL
f mQ3N�2 ' �: ,
om ssion � .�Sffie>ti]'y Public -State of Flori
• . JQ My Comm. Expires Jul 22, 2C
Commission # FF 038392
COUNTER I ROEVIEW I ZNINGS REVIEWUPERVISI REVIEW I VREVIEW EGETATION I SEATURTREV EWLE I MREVIEWVE