HomeMy WebLinkAboutBuilding Permit Application Sep 21 2015 09:35AM HP FaxFl Delta 8662190880 page 2
ALL AP IC BLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ci
Permit Number: S y
Date:
RECEIVED SEP 212015
Building Permit Application
planning and Development Services
Building and Code Regulation Division
2300 virginia Avenue,Fort Pierce FL 34982 Residential
Phone:(772)462-1553 Fax:(772)462-1578 Commercial
PERMIT APPLICATION FOR i To Select from dropbox, click here f
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Legal Description:
�• Lot No.�
Property Tax ID#: Block No.
Site Plan Name:
Project Name:_ ���
Setbacks Front
Back: Right Side _ Left Side
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HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 'IQPlumbing
❑Sprinklers L_.LGenerator Roof
Total.Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ UtilitiestSewer 13Septic Building Height:
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Name Name:
Addres Company:
City:
State: / Address:
City: State:�`� p
Zip Code: Fax:
f Zip Code: Fax:
Phone No..��a" i-1(D�
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different State oCount License: ! /7
from the Owner listed above) Str
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
Sep 21 2015 09:39AM HP FaxFl Delta 8662190880 page 3
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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: i Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application Is hereby made to obtain a permitto 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 worts
in accordanc with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The followin building permit applications are exempt from undergoing a full con rrency review:room additions,
accessory s ctures,swimming pools,fences,walls,signs,screen rooms and acc sort'uses to another non-`residential use
WARNIN O :Yo r failure to Record a Notice of Commence nt may result i your paying twice for
improve a to you pro erty.A Notice of Commencement must a ecorded an posted on the jobsite
before the f s in -to obtain financing,consul It"n r or n attorne ore
commen in ork or our Notice of Commencement.
Signature o Ow r/Ag t/Lessee Signature of nt actor/L rise Holder
NI„
STATE OF OR ! STATE OF F RID
COUNTY O / COUNTY OF 1AAW
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The forgoing in ent w acknowled ed b for r '. rt+s The forgoing in r en s acknowledged before
this da o `er"— .20 by this day f 20M[by
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(Name person acknowledging) (Name of 7n acknowledging)
ignature of Notary Public-State of Florida) _ (Sig re o Notary Pu lic-State of Florida)
Personally Known OR Produced Identifi ti Personally Known OR Produced Identificati ~
Type of Identificati Produced Type of Identificati Produced
V
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED