HomeMy WebLinkAboutBuilding Permit Application Date: Permit Number:
. . . Building. Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F4 14982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential.
PERMIT APPLICATION FOR: o m
Address:
S94 SIR,
Legal Description:
Property Tax ID#: 7- 061,0P, -coo-A 9 Lot No.
Site Plan Name: Block No.. .
Project Name: 9 Q,
Setbacks Front Back: Right Side: : Left Side;
Additional work to pe pe orme unTler t is permit—check a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
X Electric. _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Constructions: Sq. Ft.of First Floor:
Cost of Construction:$ 00 utilities: _Sewer _Septic Building Height:
Name _ (Name:
Address94 1 1:2 ° Company:
City: State:!9 Address:
Zip Code:3,q 199-a Fax: City: State:
Phone No. Zip Code: Fax:
E-Mail: Phone No. ✓`�
Fill in fee simple Title Holder on next page(if different E-Mail: M0"J�P "
from the Owner listed above) State or County License: l
If value of construction is 2500 or more,a RECORDED Notice of commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:. '> Not Applicable
Name: A) J Name: A_�'-
Address: Address:
City: State: City:
Zip: Phone: Zip:; Phone
FEE SIMPLE TITLE HOLD R: Not Applicable BONDING COMPANY: Not Applicable
Name: Name: pla
Address: Address:
City:
-city: -
Zip: Phone: Zip: Phone•
OWNER/CONTRACCOR AFFlDVlT:Appiicat<on is hereby made to obtain a permit to do the work.art installation as indicated.
I cert*fv:that no:yvork of anstagation has commenced prior to ithe issuance of a permit. -
St.Lucie Countv makes_no,representa#jon thatJs 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 andpcovenants that may restrict or prohibit such
.structure.Please consult with your Nome Owners Association and review your deed for any restrictions;which may apply.
In considera#on of the granting of this requested permit,I do hereby agree that[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 under*goinga full concurrency review:room,additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TCS OWNER:Your failure to Record a Notice of Commencement.may result in your paying twice for
Improvements to yourproperty.A Notic of to' mencementrnustbe•recordedand'posted on the jobsite
before the first inspectio you intend_to obtain financing;consult with lendern lenderattorney before
commencing work or rcor_ ,gyour Notice:of Commencement.
Sig a ure Of Contractor/Ci nse Holder ; . Sig a ure of Contracior/11161inse Holder
STATE OF FLORIDA STATE OF FLORIDA "
COUNTY OF COUNTY OF 5"-l'
;The forgoing1ri . ment aeras acknowledged before me. . The forgoing instr ment w s acknowledged before me
this:. dayof:. ri.t ..
thy. thisdaycaf r;1' X20 1
;(Name of person acknowledging) (Name of person acknowledging)
(Signature of lilotary
yPublic-Statof Florida j j (Signature of Motary Public-Statq of Florida j
Personaily Known f OR Produced ldeh#if q#a iri 1, Personally Known OR Produced identification
1"ttpe.o€liieritification Protlueed _ Ali Type of IdentIfka€ion Prdduced ARit 4
o1PR;..:ej✓c riQili+iISS10N � 51
%r Pue�,� nail}3tiSSlON s
t� .
Commission No. n;SES: 9 Commission No.' tS:A�9u """"•
8onde4'itw�ud8e�. "
. �r6'OFFL� '�TEOFFtio .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE- MANGROVE
COUNTER REVIEW .REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE.. „` . ..
COMPLETED
Rev.7/2014