HomeMy WebLinkAboutBuilding Permit Application �
-iPPLICABLE INFO MUST DIE COMPLETED FOR A91)LICATION'TO BE ACCEPTED
Date, Permit Number: iseq -C -D
Building Permit ' �rp-------'Legal Description:
'
Plonning and Development Services
audding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498Y
Phone:(772)462-1553 Fax: (772)462-1578 Commercial �eslde ntia I
PERMIT APPLICATION FOR:
�
Site Plan Name; Block No.
Prolect Name:
Setbacks Front Back, Right Side: Left Side:
Additional work to be performed under this permit–chrck all that apply:
—Mechanical —GasTank Gas Piping Shutters Windows/Doors
Electric —Plumbing —Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
costof Construction:$ Utilities: —Sewer _Septic Building Height-
Phone No. Zip dode; 34 Fax;
E-Mail: Phone No. 772 33,T -30-31
-Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: CAC06IRio
if value of construction is2VWor more,a RECOROED Notice of Commencement is required.
MDESIORNEENGINEER: Not Applica ie MpRTGAGE COMPANY: Not Applicable
Name: Na re*
Address: Address:
City: State: City State:
Zip: Phone: dip: _Phond:
FEE SIMPUE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Nacre:
M
Address: Address:
may' City:
Zip: Phone: Zip:�„^Phone:,
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
1 certify that no work or Installation has commenced prior to the Issuance of a permit
St.Lucie Count makes no representation that is granting a ermit will authorize the�iermit holder to build the subject structure
which is in con ict with any applicable Home Owners Association rules,bylaws or and covenants that may refrict or prohibit such
structure.Please consult with your Nome 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 Suildipg 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 faildre 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
commenting work or recording our Notice of Commencement.
Signature of owner/Agent/Lessee Signature of Contractor/license Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 7 L U c I e COUNTYOF. .
The forgoing instrument was acknowledged before me The forgoing instrument vias acknowledged before me
this,_day of .20_ by this---I-_day of .2 by
pur �!C J-AmrnornS .._ l�uxZ7"js fir jp rC
_ w ,
(Name of person acknowledging} Warne of person acknowledging)
(Signature of Notary Public-Ste of Florida) (Signature of Notary public-State a rida}
Personally Known____ OR Produced identification Personally Known t✓..._OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. C6 J 694P . 1) eXPIRES:AFrii142017 Commission No. "�°3f�dd°� �Ie�
`°'�tt ikndwdlhoe+q�tNc�! �� EXPIRE6:Apn1l,�li4
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TL R"ME MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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