HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:
owl 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:
`PRf3PQSED INPROVEMENT LOCATION.
Address:
Legal Description:
Property Tax ID#: � � — 7�� O d 0 ( O O O — Lot No.
Site Plan Name: Block No.-
Project
o:Project Name:
Setbacks Front Back:. Right Side: Left Side:
Dml,LED�DESCRIPTION ) WORK
vl
7� ly
,,P0 CT INFORMATION:
Add' lona workto epe Orme under this permit—check a that appy:
(Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �� Utilities: —Sewer —Septic Building Height:
OWNER JLESSt CONTRACTOR.
Name_ A��rn-s ��,v�� IL—a c Name. -M't�� S it D
Address: Company,:,
City: /�>` -PZ. '` State: r L Address; Z' % c u sq
Zip.Code: —3Fax: City:^ aC C_ State:
Phone No. Vd/- /z !j41 Zip Code: 3615 R � Fax:
E-Mail: Phone No. 7 7.:)
Fill in fee simple Title Holder on next page (if different E-Mail:
from the Owner listed above) State or County License: ('A y IcU �-
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
%5UPPLEMENTAt `CONSTRUCTION LIEN lAW INFQzRMATION:
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 thepermit 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
comme ng work or recording our Notice of Commencement.
Signature of Owner/Ageno Lessee Signature of Contra ctor/Lic s Holder
STATE OF FLORIDAJJ STATE OF FLORIDA -
COUNTY OF COUNTY OF
The for g ins tr t wa r cknowl edge re me The forping instru gent wa cknowledged�are me
this cay of 20 this day of 20� by
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(Name of person ackno (edging) (Name of person acknowl dging) U
J
(Signature of Notary Public-Sta a of Florida) (Signature of Notary Public-Sta of Florida)
PersonallyKnown OR Produced dentification Personally Known OR P o c Identification
Y
Type of Identification Produced Type of Identification Pro
' iyY plll, DAWN MILONE .,�o<PRY Ptis• CS
Commission No. .�o�P °e;? I Commission No. = • Not�rWN MiLDNE
. r; NAW �ublic-State of Florida ,
•=My Comm.Expires Mar 22,2017 o.+ r?MY Comm�Eic-State of Florida'
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REVIEWS FRON PLANS VEGETATION i�T� 9r,.gv1, N� Q�Y,
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW RE'�I
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014