HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��� Permit Number:
rr
- -- _ 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
PERM IT APPLICATION FOR:
PROPQSED IN ROUEMENI' I.®CATION:
Address: -7 ( ue-� M Gr rC
Legal Description: 2)2
Property Tax ID#: Lot No.
Site Plan Name: R, GAS� Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DfTA1�LED DExSCRIPTION OF WORK:
CONSTRUCTION IWARRNIA ION:
Aaditional work to be pe-ffo-rmed 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: $ �'j, n n Utilities: —Sewer _Septic Building Height:
OWNER/LESS E: 0,i5ITRACT®,'R:
mrmr �n,rnv �rwmr
Name ��� �Q CcD�t�'I��t� �i'eS Name: 4e_
Address: Company:�/�!/�IP
City: ;! 6tcM State: Ml-_
Address: 7 W O
Zip Code: If Jgv d 41 Fax: ,s City: /U e- �J I-of-1 0 fQC4 State: FL.
Phone No. (FE-g— gsg-gs Zip Code: 3-A � Fax: L3 4i(�-3 �fs®
E-Mail: Phone Not 361d �;- - 7419
Fill in fee simple Title Holder on next page (if different E-Mail ci/ 'q(15fi,►ne.4(D Cf/,e'� C o
from the Owner listed above) State or County License Fgi 34 ) �
JEvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
tA4 Ci - Q,Vvt -
SUPPLEMENTALC4NS!1T!11 PION LIEN LAW hN+FORMATION:
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.
Signat a of O er/ es a/Agent . Si nature of ctor/License Holder
STATE OF FLORID - STATE OF FLORID
COUNTY OFA COUNTY OF
The forgoing inst men was acknowledged before me The forgoing instr, ent w s acknowledged before me
this day of 20 by this D2 day of 20� by
(Nam pers ack ledgi g) (Na of pe on ack ledging)
1
Gly-Vv� -
(Signature of Notary Public-State of Florida) Signature of Notary Publi -State of Florida)
Personally Known OR Produced Identification Personally Known OR�Rrod . e Identification
Type of Idw, cat �— Type of Iden ifi a or`;"" p
Produced Produced - tars p l mV
„+ Comm Expires) rFP,�r'r,,.;aa
�.�'�,N Y'P��/' ,..I/OF tLJ`���. Commission fo vil !. 7Sk�
Commission No. (Se WN MILpNE Commission No_ """' d Th "'>>0, `
' 9h National `f
•i, k �: `
Notary Public-State of Fiorid NotarYAssn.re
Commi mar 22 201i
ss on
REVIEWS FRONT,-,.. .. l`NG'hroug � n WROR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REV}E, 'ZOW -- r_,'W' J Issn.- REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.