HomeMy WebLinkAboutBuilding Permit Application .piLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BJE ACCEPTED
Date: f - — – Permit Number: f 1 - a -
Building Permit Application
Planning and Development Services
Buildtng and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498,2
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
AM- -
Address:
Legal Description:
Property Tax ID#: al ��"'L'n �t�Gd / Lot No,____ �_,__
Site Pian Name: Block No.
Project Name:
Setbacks front Back: _Right Side: Left Side:
_?,Seer r C�Arv. O
1z 0
rona work to i3epertorried un'der this perm –check all that app r
_,,,_Mechanical Gas Tank Gas Piping _Shutters Windows/Doors
_ Electric Plumbing Sprinklers —Generator Roof
Total Sq.Ft of Construction: Sq.Pt.of First Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
Nameuta'.!' ' Name: Cur tS Sg, mors S
Address: cf ll Company' 1sx&x A t r�+e ws )Air.
City: „ 'J `` 'i State:- Address: if IS- Sly `V i I(Q.4 e. .r, N- ]k
Zip Code: Fax: City: .-C L44-!r�– S#ate-_f�.
Phone No. Zip Code: �S Fax: 71a 335 I &
E-Mail: Phone No. 7%, -
Fill in fee simple Title Halder on next page(If different E-Mail: c usta,1r cut C',16cm_
from the Owner listed above) State or County License: Cft C 0�1 R 1O ' S
If value of construction IS2tre0F"Or more,a RECORDED Notice of Commencement is required.
� �O
DESIGNER/ENGINEER: _Not Applicable MpRTGAGE COMPAwY: _Not Applicable
Name: Name:
Address: Address:
City: State: City:
Zip: phone:- Zip:_..:. Phoria: -
FEE SIMPLIE TITLE HOLDER: ,Not Applicable BONDING COMPANY: ,,,,^Not Applicable
Name.. Name:
Address: -- Address:
Zip City: Phone: Zip. Phone;
OWNER/CONTRACTOR AF'FIDVIT: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.
5 .Lucie County makes no representation that is granting a permit ill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rues,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 Suildlpg 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 Cornmencement 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/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF I„V C 1 COUNTY 0+FLORIDA s T
COUNTYOF S 7
The forgoing'nstr 3UPe
nt was acknowledged before me 'The forgoing ins me was acknowledged before me
this 42L-day of 2dZrby this,�day 2krby
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public Stn of Florida) (Signature of Notary Public-State of cion)
Personally Known OR Produced Identification Personally known OR Produced Identification
Type of Identification Produced Wftw. rucwMa 90MH Type of Identification Produced
gas
MY�IFE .,
commission No. s9 8y "` i} EXPIRES:Apttlt,2017 Commission No. . ��; d/ * gyC01411li f7Nomm�iEE
%7W eonaeellxneueettr,�Y EXPIRES:J1
�� P 4,201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.