HomeMy WebLinkAboutBuilding Permit Application All APPLICAB//LE��INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t!�• r Permit Number: ( >
RECEIVE®
Building Permit ApplicatiWUN -3 2015
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:
Addresses l :z�i P1EeC'6 W D Fl. 3 i�
Legal Description:
Pr p yTaRlD. 1 3b 1 605 —ba90 6:06 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
l f 7 v �F 4 ' :-(t (��, °we'd C,
rtional work to bepe orme un ert ispermit—c ec a,,:t at app y:
_Mechanical _Gas Tank Gas Piping Shutters _Windows/Doors.
Electric _Plumbing _Sprinklers Generator Roof
TR S(f -'Construction-. Sq:,Ft:,.of First Floor:
Cost of•Constructio$ 4`"D 0 Utilities: .Sewed _Septic Building Height:
x
Nam F Name:' ..
Addreess:_(O--I.O_►_-_�T_P ezz6 u C) Company:
Cityi �r �C `z State:r1..— Address:
Zip Code: !3!AQ Xa1 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
from the Owner listed above) State or County License
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
commencing work or recording our Notice of Commencement.
Signature of Owner/L ssee/Agent Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrLMntwas acknowledged before me The forgoing instrument was acknowledged before me
this day of 20K by �;b;w••., this day of 20_ by
(Name of person acknowledging) X�a (Name of person acknowledging)
p
2 MR 9
� ins�
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(Signature o ary Public-Stat of Florid �T (Signature of Notary Public-State of Florida)
C�-n X
Personally Known OR Produced Identific �?8- Personally Known OR Produced Identification
Type of,lpen' is tion a Type of Identification
ProducedProduced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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