HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
RECEIV-D DEC 112015 .
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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 I/
PERMIT APPLICATION FOR: To Select from dropbox, click here v G
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Site Plan Name: Block No. (02_
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Add itio nal work to be ertormed under this permit—cec all appy:
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Electric 0 Plumbing Sprinklers FIGenerator F]Roof
orai sq.ri Or Lonstruction: J .hi.Or 1 lrsi boor:
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Cost of Construction:$ ��� — Utilitie�'UewerF]Septic Building Height:
OWNER/LESSEE _ CONTRACTbR� r , 7'
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Name of fenC'o_ Name: Am
Aaaress: I� company: C tlt-` he r kurl° R
City: rr cc�� State: Address: �� Y ° Pnlle-
Zip Code:c: 40ag%___ Fax: _ _________ City: Y-� pea'e_ _ _ __ State:
Phone No.T�Z- Z_Lg3— DQ714 Zip Code:34Q 87, Fax:T1L-t4�5-Lf4qS
E-Mail: Phone No.1—IZ—LKO 5—1000 p
Fill in fee simple Title Holder on next page(if different E-Mail: Q at r +5(&) Corti
from the Owner listed above) State or County License: t0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN.-LAW-INFORMATION:
DIESiGNEWEN611YEEit: _Not Appficable MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address: Address:
SI:ai:f=: Ci1.y. .:Iv.att_.
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: ___ Not Applicable BONDING COMPANY- __-Not Applicable
Name: Name:
Address: Address:
City: City:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certifv 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 thepermit 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.
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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
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i ature of Owner/Agent/Lessee r Signature of Contractor/License Holder/
STATE OF
STATE OF
COUNTYOFORI t/L .:LC/C�lCO NTYOFORfL�A1,-7't .L(0C'a
The fo oing in ument was acknowled td before me The for oing in ment was acknowledged before me
this 11�`day of n r 20�by this I Vday of�2C'.endOer .20 Wby
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(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary •S ��fif F f5r ( ign>ature of Nota�c-Stat' �lprii(�
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PersonallyKnown Q .•�XpIRFS .•�C ��
'fit Pr; &i1ft ication Personally Known OF r��' r44i ntific ttl�G
Type of Identificatio t d I o 1 Q= Type of Identification Produce uJ: • �� _�_
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Commission No. �% •':� e;: �1) Commission No. .
NOTW �� :°"mac':
Revised 07/15/2014
R EV!E%A'S FRONT `rn 11 SUPERVISOR VISO�'\ . n � )I,` I- 1111.1 S -1 R—r
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
ICOMPLETED