HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: KnD�
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 V/11L
PERMIT APPLICATION FOR:
q RCJPU5 �1,�1.1PR01lENT L, ,.
Address: ®7 r 147 1 ar: * 63 je* ��/' 57
Legal Description:
Property Tax ID#: d7 9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Zhanical GTk GPiping ShuttWindows/Doors
— — asan — as pg —Shutters -
-Electric —Plumbing —Sprinklers —Generator —Roof
Total Sq. Ft of Construction: °� Sq. Ft.of First Floor:plZkO
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
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Name Name: -10M vow.,Q
Address: g7)�` Company: 51&". �,�
City: �� 4 State:_ Address ''t
Zip Code: ' 419 r7. Fax:-ties City: � �'d- ,; State d
Phone No. ,'• -����- Zip Code: 3� � 3 4e� Fax:
E-Mail: (A` Phone No I l 7
Fill in fee simple Title Holder on next page(if different E-Mail evom Q
from the Owner listed above) State or ounty Lic se ) p
if value of construction is 2500 or more,a RECORDED Notice of Commencemen i required.
PPLE AL CONS Rl1 T MAIlle
"� QilN IN, 1?FORMA$
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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.
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA l
COUNTY OF COUNTY OF
The f r ing instrum �t was ari knowledged re me The forgoing instrument was acknowledged before me
An
this day of J 20 y this day of 20_ by
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(Name of per acknowledging) (Name of person ack Nedg
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(Signatur of otary Public-State of lori a) (Signatu a of o ary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of I d1kntWQti0.L
Produce
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REVIEWS FIST-.. I N G SUPERVISOR PLANS VEGETATION 'Cssn MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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