HomeMy WebLinkAboutBuilding Permit Application � ADatePLICABLE INFO �V�ST BCOMPLETED FOR APPLICATION TO BE ACCEPTED
Permit
- - - 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:
Address:
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
f 'ETAI>LED ®`ESCRIS�TIQNFWO`RKa $'
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N1, R, INFORM 1TfON � �� rC"�
Additionalwork to 3 e pertormed under this permit-crieck all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: , t� b ) � Sq. Ft.of First Floor: ` � C
Cost of Construction:$ 1 (cJd O O Utilities: —Sewer _Septic Building Height:
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01NNER LESSEE NIRA TORSRe
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Name \ T---, S LA e:`
�
C.
Address: 'yl `\Q" C `.-Ac Company;
City: Sc� State: L Address: 14 \C
Zip Code: Fax: City: State:
p�
Phone No. Zip Code: �{� �j� Fax: <23�—c��
E-Mail: Phone No �� `� C��—eD,Qk(:k
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
Lt—t
of construction is 2500 or more,a RECORDED Notice of Commencement is required.
1
SCUP. L=1V TAL C®'NST`Rtl1CTl®N L1E�N LAW 1N'F®R+MATION.:
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 le der or an attorney before
comme workpr recQrding your Notice of Commencem
Sigure of Owner/Lessee/ rTATE
ure of Contractor/Lice er
STATE OF FLORID ` OF FLORID
COUNTY OF `C �C-L� COUNTY OF �_KC)
The f�going instrum t was acknowledgQdq- fore me Th rgoing instru nt was acknowledge b ore me
this day of 20 y thiday of 20 by
6\:�
(N of person acknowledging LL (Name of person acknowl dging)
(Signature of Notary ublic-State of Florida ) (Signature of Notar Public-State of Florida)
Personally Known R Produced Identification >P e sr ovally Known OR Produced Identification
Type of Ide i ti n
ANGELA M HUFF i
ro uced ,••;•�"�°''�,,,, Produced' ' ",r ���un; ANGELA M -
c- tate of Florida `� , �4 Notary Public-State of �l
+ � 31
+ commission# 30
Commission i3'� oc ���� Commissi •- n�FF 23
.Expires ay 2 2019 a
"'^���`•••
Bonded fhrou h MY Comm.Expires May 21,2,619
g National Notary Assn. y�'••°e+ `�d� F9nmrt�A ru r
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014