HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO:BE ACCEPTED
Date: W u �� Permit Number: j cl lP- 0OW011
EC. 11ED
Building Permit Application JUN -4 1015
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:
Legal Description: 1 I0_n _Iocr . U 4�s � q
Property Tax lD#: �5 qo @ JbQ0 - b4'8-3-000,3 Lot No. � H L/
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left,Side:
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re
�l�Cr3'� l faLi�
itiona ork to be periorme un ert is permit—check all t at app y:;
_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 V.Septic Building Height:
Name r 1n Name:
Address: Company:
City: ToeAt CY-W State: Address:
Zip Code: 3 q(2 Fax: City: State:
Phone No._ ���- ��' C�15��0 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..
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
commencing work or recording our Notice of Commencement.
YU
Signature of Own r Le /Agent Signature of Contractor/License Holder
STATE OF FLORIC�9 STATE OF FLORIDA
COUNTY OF COUNTY OF
o
The for oing instrprt nt was acknowledged b. gtprfn The forgoing instrument was acknowleg ed before me
this day of 20/�� + o this day of by
V �
iMs
a •
sg
(Name of perso acknowledging) -8 (Name of person a dging)
(Signature of N•tary Public-State of Florida 61 (Signature of No ary Public-State of Florida)
Personally Known OR Produced Identification Personally K own OR Produced Identification
Type of-Identification Type of Ide tification
Produced Produce
Commission No. (Seal) Corr ission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.