HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO TUST BE COMPLI I FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Icz,
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: 2 > �C� 09-
Legal
9Legal Description:
Property Tax ID#: 1,L-,1.'7.--7o1 —lo®5' 000Lot No.
Site Plan Name: Block No. 1
Project Name: °e� L C - t
Setbacks_ Front Back: Right Side: Left Side:
Additional work to be pertormed under this permit—check all that appy:
MeaKanical _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:$ 2-000 OD Utilities: _Sewer _Septic Building Height:
Name ` tr Name:
Address: `Z Company: 44
City: State: Address:
Zip Code: O Fax: City:
Phone No. Zip Code: Ins - Fax:
E-Mail: Phone No 32-3-- 5 J?
Fill in fee simple Title Holder on next.page(if different E-Mail 4"--c c—e 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.
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 wo r recording our Notice of Commencement.
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Signatur o Owner/Lessee/Agent Signatur Contractor/License Holder
STATE FLORIDA. f e STATE OF FLORIDA,
COLIN OF ` [—.CSLC� �— COUNTY OF (�
The fo going instru nt w ack owledgere me The for instrumen was acknowledge efore me
this day.of 20 by this day of ` 2 by
(Name of person acknowledging) (Nam person acknowledging)
(Signature of Not Public-State of Florida) (S'Ignature of Noff Pu lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification.
Type of I Type of
Produced
ti,1�"4''.d OFF Produc aunJIM;
WIGFY Public--State of Florida �` EL
••; Commission FF ' �'- Notary public A HUFF
Commissi r •� yplres Ma} 1 2b19 Comm y e� State or Fln�,a
C
o•.. a on #
^"M•���•• Bon�d.through National Notary Assn «f; My Comrn FF 234,..,,.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW - REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014