HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: S�A_ d� -J
RECEIVED AUG 03 2015
_ 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:Ir \ ` �•\
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Address: S�303 �a�L�ri , f
Legal Description:
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Property Tax ID#: �� (r,()�( � d 3 -�6n --S- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed uncler this permit—check all that appy: f
_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:$ /'p � 06 Utilities: / Sewer _Septic Building Height:
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Name Name:
Address: S?/)oE ��� ��. Company:
City: % eye - �_ State: Address:'
Zip Code: Fax: City: State:
Phone No. -7` ,2::: S'—S'�5� Zip Code: Fax:
E-Mail: . _ Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) Stat r County License
IEValue 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 exmpt 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 th first inspection. If you intend to obtain financing, consult with lender or an attorney before
commenVinV work or reco/d-7&your No ' e of Commencement.
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Sign Owne Lessee Agent Signature of Contractor/License Holder
ST F FLORIDA STATE.OF FLORIDA
C Y OF 5'� • Ly COUNTY OF
The f_grgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this `1 day of 9!!�A 20LS by this day of 20_ by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu lic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identi ' Personally Known OR Produced Identification
Type of Identification ur PMO stake of F\o6da Type of Identification
Produced L iQ L PUb"c-stake ec 10.2016 Produced
_ `µv Pue��i Nota�Y ExP�es EE 85861
Commission No. �E 'toa�ooatNou'll sn ommission No. (Seal)
;s�• +� 8 odedthcoU9hN
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
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COMPLETED
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