HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: . ` Sfi Z0 S Permit Number:
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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: O �O YO L �f Z
Legal Description: '
Property Tax ID#: oZ�Fa' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:
Nil ONE=.
2 IN
v ; 7h
OffinonaForPtoape orme uner tis permit—cec atat appy:
_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:$ 00 o O® Utilities: _Sewer _Septic Building Height:
70ty:
I C`Z h�2(J Name:
Company:
tate:CL Address:
Zip Code: 34 cl Z Fax: City: State:
Phone No. L- 2-6 • U 3 Zip Code: Fax:
E-Mail: at-7 Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or C my License
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: w Not ApplicableMORTGAGE 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.
1 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 thepermit 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.
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Signatureo nerJ Les a gent Signature of Contractor/License Holder
STATE OF FLORIDA J STATE OF FLORIDA
COUNTY OF c> COUNTY OF
The fo going instr,,me was acknowledged before me The forgoing instrument was acknowledged before me
this day-of 20 : by this day of 120 by
ry1
(Name of person acknowled ing) (Name of person acknowledging)
{Signature of No ry Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Know I n 'fic tion Personally Known OR Produced Identification:
" `o• ANGELA IfA HUFF Type of Identification
Produced
Produced ?�. *°Z
Not PuhtlC"State of Florida
-X:- commission#FF 234730
Commission N .�N�'.:;Qf��-M My Comm.ExpirIggg 2Q19 Commission No. (Seal)
8011110"rough National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014