HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO, 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:
PROP®SED INPROUEM-E'NT LOO CATI'®N: \ !i
p ,
Address: ��
Legal Description:
Lot y is 6 No.—A'2
Property Tax ID#: L6-r�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Is I 11-1
DETAILED DE-SCRIiPTI®-(U ®F UU®'RcK: 1111
4ce,
CON'STRtIJCTI®N INF®RTATIi®N:
Additional work to be pertorme under this permit—check all that 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:$ Utilities: _Sewer _Septic Building Height:
Pawn ill..01IVN'ER/SLE-�S EE: arm
CONTRACTOR•
- -
Name d pp Name: «%
L L
Address: �- �� Company: (."'-
City: Statel—" Address:
Zip Code: , �� �� Fax: City: yt� C Stater[
Phone No. �'� 2 72- 17Z Zip Code: ?p'l Fax:
E-Mail: J� Phone No -5— �'72 S
Fill in fee simple Title Holder on next page (if different E-Mail a c.
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sll`PPLEMEN 1L CONSTRUr�TLON LI N LAW fG RNIATtffi:WN:
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.
Signature of Owner/L see Agent Signature of Contractor/License Holder
STATE OF FLOR!1% STATE OF FLORID
COUNTY OF COUNTY OF
The fo ing instr ent s acknowledged efore me The f oing instr ent as acknowledge ore me
this 77day of 20L by this day of 20�by
Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-S to of Florida) (Signature of Notary Public-State of Florida)
Personally Known , ro uce Id(DrrAVW Maio* Personally Known gduced Id@AWNdaltirdltE
Type ,o wP Notary Public-State of Florida =?+ Notary Public-State of Florida
T e of Identific ion' .SPR °a�,� Type of Identi 'catio
Produced , r= • i`c Comm.Expires hoar 22,2017 7 produced '?M}'Comm.Expires Mar 22,2017
;.• o; Commission # EE 877571 sfFOFF��o' Cummission#EE 577571 '
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Commission No. Bonde Slggq � Commission No. -�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Re—v.