HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r-
Date: Permit Number: /So-1 •01 �0
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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:
K address: Z005 M• .qL--V"� �t
Legal Description:
Property Tax ID#: TOIL" �I COD 0M ' 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks, Front Back: Right Side: Left Side:
IkDrit for "wQrc- A I c, Qhc�_nn e ,04 '
Additional work to be performed under t is permit-c ec a tat 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:$ �Q��� Utilities: —Sewer _Septic Building Height:
Name ��iS V�Q�� Name: o
Address: 3`C05 M. LAU 6fi• Company: lei i ��0�h n
-City ' 1 Ork Ti N=YC 'e, State: FL Address:) 0 N. F106& ku&n
Zip Code: - I0i LA�1 Fax: City:l►SeSk, PCO M 1�31erxck
Phone'No. a "a 0� 61503' � � Zip Coder 35yW Fax' 5(p1 �12p paOla
E-Mail: Phone No 5cotl - RL14 .5-10t 0
Fill in fee simple Title Holder on next page(if different E-Mail ���Y4�flQ+riC11eC1
from the Owner listed above) State or County License CaPIC,1
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.
s Si ture of Owner/Le tgent Sig ture of Contractor/License of er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY-OF 7�_X _Q COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this, day of tMO., 20_IS' by this 4 day of 20 13—by
Y y
( ame of person acknowled ' g) (Name of person acknowledging)
rybo(Sihnatqreof Notary Public- tateofFlorida) ( gNooPtate of orida)
Personally Known OR Produced Identification Personally Known OR Produced Identification:
Type of Identification Type of Identification
Produced_V�4'*M UQ�,S-Ool-r,?,, -191 Produced
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Commission No. mission No.
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OMNI G A�•����o . II *� Notary Public-State of Florld
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REVIEW REVIEW
DATE
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DATE
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