HomeMy WebLinkAboutBuilding Permit Application -dJPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 9-,Q,5 Permit Number-
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
[P�M—ITAPPLICATION FOR:
Address: -34 4ow-+e, LzicsA
Legal Description:
Property Tax ID#: 31414 '5 C)I rl b Lot Na
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
13SI-et' <,-XA4 05-e
Additional work to be performed under this permit-chock all that apply:
—Mechanical Cas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor-,
Cost of Construction:$ &L Utilities: _Sewer Septic Building Height:
rNameNamer JA &4rL6 Sa. Wor),5
��—s Company: j' «~ -At'r �4s+e.jvi kl(�
Address:
City. -pYN Ck Q-,V L-0 64L State: Address: 15 9J i I F�-e ti
Zip Code: aLA f2- Fax: city: fo d 6 State:
P-T — L
5 T bi c e— JL
Phone No. 19 2.- 919-,Z9 9 zip code:. 34,55;b Fax:
E-Mail- Phone No. 33;S
Fill in fee simple Title Holder on next page If different E-Mail. C-U-tAlr �4'q 'P C'0)'e'm
from the owner listed above) State or County License- CA C 05 1810 S40Ae,
If value of construction is, Wfror more,a RECORDED Notice of Commencement is required.
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.
5t.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,l do hereby agree that I will,In all respects,perform the work
iri accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
Thefollowing building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms apd 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 recor 'Vg your Notice of Commencement.
Signature of Owner/Agent/ essee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF _
The forgoing instrument as acknowledged before me The for Ding instrument w s ackn wiedged before me
this day of �' 20 4by this day of Q&by
Q!�Ci M rn e7
.1 m_ a of person acknowledging) (Name of person acknowledging)
Signaxture of Notary PW -State of FloFida
gnature of NotaryP70R
tate of Florida) )
sonally Known Produced Identification Personally Known_te'o". OR Produced Identification
e of identification Produced Type of identification Produced.
commission No- (Seal) Commisslon No. 'Lt. o�.. (Seal)
REVIEWS FRONT ZONING.,. ' SUPERVISOR, PkANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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