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HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED �v ' Date: -� 1 2- 2 O l�°S Permit Number: A i r 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 PERMITAPPLICATION FOR: Address: Ck's is 1%} •, f p lc-e,J �� . . 3 �1 ��`� � u09 - Legal Description: ' 1 ' b075 Property Tax ID#: 3 q © 2 l O " I'�-7 - d0 �3 Lot No.-;N 4 2) Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: M@1 fil Ma itiona work to be pertormed under t is permit-check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors —Electric '! 7DESIGMNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable : 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 mencin work re ording your Notice of Commencement. gnature of Owner/Lessee/Agent Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF .1.ap, COUNTY OF , The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this day of 20LZ�',by this day of yhgL ,20J: by (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary Pu lic-State of Florida) (Signature of Notary Public State of Florida) Personally Known OR Produced Identification'. Personally,Known OR Produced Identification Type of.Identification Type of Identification oduced' Prm duced sato•',k4!s�- 4S a,Cf i.-o is 51�,U.44S-.4s.a(%b Commission No. (Seal) Commission No. ,.•tP"�^�e�.,, fS6� ANNA I to of F �- Notary blic-State of Florid *Z1 My Comm.Expires Dec 20,2018 v^VB /,F DF F1.Oa. Nota y FF I F orid ""1O"�� Bn d thio i I Ass . REVIEWS FRONT 6My C ARN1 c 0 2 - NS VEGETATIOCOUNTER C mmi7j q�f` IEW REVIEW REVIEW REVIEW DATE Bonde through nr,r"nal :,ta a ; RECEIVED DATE COMPLETED Rev.7/2014