HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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:
PROPOSED INPROUEMENT LOCATION:
Address: �� 7l PZ&V?2/p/
Legal Description:
Property Tax ID#: 3 3 Z Z s�S 6 O ®� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�=AIILER DESCR�IPTIO'N OF V1/ORK:
CQ�NSTRIJCTIO�N IoNFORMATION:
1 ional worK to be pertormed uncler 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: $ y�0 , Utilities: _Sewer _Septic Building Height:
®UUN ER/LE�S�S,EE: C®NTRACT®R:
Name
8176 rpecrn�/�cr1 e4d4?K �Y 'iCom an .,
Address: ip .y:;
City: /94-4 5'Z-. Ahae State: �`Add'ress:
Zip Code: ;3 qqn6 Fax: City: State:
Phone No. ._cFs Zip Code: Fax:
E-Mail: 6Ekf• Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State o ounty License
JLtaLlue of construction is 2500 or more,a RECORDED Notice of Com encement is required.
SU'PPLEM'ENTAL CONSTRIJ'CTf'DN LIIEN 1EV fNFORM,4T10N:
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 a/Agent Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF IL_Q,_C�� EL COUNTY OF
The fo oing instruy�ent as acknowlecla fore me The forgoing instrument was acknowledged before me
this day of U 20LD by this day of 20_ by
`bc�c\[-�'� s Vern e
(Na of person acknowledging) (Name of person acknowledging)
(Signature of No y Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificai Type of Identification
Produced Produced
'`=0.�,0.Y P�,�,,,� ANGELA M HUFF
Commission No. _ •`I Nota"giltc.State of Florida Commission No. (Seal)
" • ' Commission#FF 234730
=;.F. „P" MY COMM.Expi
H"(WO'd throup National Notar Ass
REVIEWS FRONT Z N'1�7 "SUP ERV. PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.