Loading...
HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: Permit Number: - 050M 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: PROPOSED INPRMY BENT L©CATt®N: Address: Legal Description: Property Tax ID#: Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DfTAI;LED DEaSCRIPTI(JN OF WORK: . o 2r 15-60 z 3 r CONSI'R+l1CTi0N INFOR+IVIATION: Additional work to be pertormed under this permit–check all that appy: _Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors Electric _Plumbing _Sprinklers _Generator f/ftoof Total Sq. Ft of Construction: I TUU Sq. Ft. of First Floor: b'-oo Cost of Construction: $ �5'?j0 Utilities: —Sewer —Septic Building Height: OWNER/LE=�SSE�:E: C®NTRAC�T®R: Name (v +•J Name: C AddreCompany: c+.► 'C_ City: 4_ C2('t-,e State: F i Address: Ska Rtj�- `r Zip Code: �G�( _ Fax: City: c-k c'e_ State: Phone No. Zip Code: `3 '1`5( _ Fax:77aGg-016t E-Mail: PhoneN o�( X30 Fill in fee simple Title Holder on next page (if different E-Mail S P from the Owner listed above) State or County LicenseCc[–O 08 S�Z If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. SIII P.,Ra IENTAL C®NSTl {11C1'IC}N 1 ER id I I I IN�FO'RIUITA►T a ' 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 Commep cement may result in your paying twice for improvements to your property. A Notice of Commencement ust be recorded and posted on the jobsite before the first inspection. If you intend to obtain financing, cc suit Ith lender or an attorney before commencingwork or recordingour Notice of Commencemen . Signature of Owner/Lessee/Agent Signa ue o Cont actor/License Holder STATE OF FLORIDA STATE FLORIDA COUNTY OF COUNT OF � kit 'Le The forgoing instrument was acknowledged before me The fa oing instr nt was a knowledged before me this day of 20_ by this o ay of 20 Irby C (Name of person acknowledging) ( am of person acknowledging) (Signature of Notary Public-State of Florida) Signature of Notary Public-St6 of Florida) Personally Known OR Produced Identification Personally Know Q ro,OL d-1 e_ FLca ' Type of Identification Type of Identification •,,aYPLASHAHNA INGRAM Produced Produced ••'�`r e`�: Notary Public State of Florida My Comm.Expires Dec 20,2018 Commission No. (Seal) Commission No. -"9, s;' Comq,6i f)# FF 177249 Bonded through National Notary Assn. REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED ev.