HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO IYUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l Permit Number:—]
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:
Address: 61 a f
11
Legal Description: L o- a i oce 51:1dC'X&C. fA4e5
Property Tax ID#: : 6 � o O 1Sq Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front�_ Back: Right Side: Left•Side:
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Additionalworkto a pe orme under this permit–c ecWOMRalithat app y:
_Mechanical _Gas Tank —Gas Piping _Shutters _W.indows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction, Sq. Ft.of First Floor:
Cost of Construction:"$ Utilities: —Sewer —Septic Building Height:
AName Jn!
Address:= ,,m�,. . ���� Company: X50 Cl–
City:
LCity: jF4 pi ere' StateF G. , {Address:
Zip Code: 34102- Fax: City: 1�... _�%'c''c'�'~' Stater
Phone No..7 7- � ( "��Z�- Zip Code:, 32 75 Fax: 4,-
E-Mail: iv4— Phone No 7 Z " 20/"/
Fill in fee simple Title Holder on next page(if different E-Mail A,-
from the Owner listed above) State or County License
i
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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...
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
commencingwork or recordingour Notice of Commencement.
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Signature Owner/Lesse gent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C& Q COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this it day of 1' )w h ;20 IS by this 18 day of 20 I� by
me o persona nowle ng) (Name of person acknowledging)
Signature of Notary Public-State of Florida) tSijWature of Notary Publi State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of.Identification Type of Identification
Produced ^ Produced
LAS
Commission No. (Seal) Commission N :s ? Notar p�blAic NA 1gU),1
9r �,=MY Comm.E pire ate of Florida
x s Dec 20
Com 20f
L d�th249FloridaREVIEWS FRONT � �bt�f oSU1�5E,R �QBe 2oJL� VEGETATION ' ` <11'd6 ROVE
COUNTER f I `_ v C�nYa FF' �1 �+IE REVIEW REVIEW IEW
DATE Nauonai
RECEIVED and
DATE
COMPLETED
ev.7/2014