HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUS BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �U 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
PERMIT APPLICATION FOR: CA—
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Address: _500rS CJl) ( 1� pC i 2 e►C-6 -�" /
Legal Description:
Property Tax ID#: rr� ® C 1 V Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itiona work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First.Floor:
Cost of Construction:$ ��/� Com' Utilities: _Sewer _Septic Building Height:
Name J&3G 1, -- - V( QUR Name:
S I
Address:•'��� S�� e IV A V&
Company ':.�, � �o C C.
City: State: L• Address: •4Pu�
Zip Code - � r� Fax: City: _,'-',",State:��
Phone IV6. ...`'.7 7''Z Jr' 2 c? Jr tr Zip Code: SC'3 Fax:
E-Mail: Phone No ( , _7,R ZII-73
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License zFdl3UW f Y-;Q
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S�t1!PPLEMENTAL C®NSTRUCTfON LhEN LAW I�NF®RIIUTAI"I,dN:
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 f' st inspection. If you intend to obtain financing, consult with lender or an attorney before
commen ' Work or recording our Notice of Commencement.
Signature of Owner/ ess /Agent Signature Contractor/License Holder
STATE OF FLORIDA J STATE OF FLORIDA
COUNTY OF ,�— l �C J COUNTY OF
The folgoing instrum t was alp, nowledge ore me The fergoing instrurizp nt was ckd be nowledgyore me
this day of 20 by this rC, day of 20 y
(Name of person acknowl dgin (Name of person acknowledging)
(Signature of Nota Public-State of Florida) (Signature of tary Public-State of Florida )
Personally Known O Prod ced Identification Personally Known OR Produced Identification
Type of Identifica Zn____ Type of Identific 'o
Produced AGE FF Produced
Notary P011C a ot.Flotida ,,��otpRYp`y�
Commissi �,•= Comndsslon' FF YCr 3019 Commission No ° :"e %tdryp�b��t� }}�
y My Comm. plres MaStat
° Bondedthrai9�tJatlwwNotaryAssn. �� oFF�oP;°�'`My�ommisslon# 23�forida
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ed throv8h' s a iu
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION S a1N ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW W
DATE
RECEIVED
DATE
COMPLETED
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