HomeMy WebLinkAboutBuilding Permit Application All APPILICiABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1� �� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:'��j�
ff i e ,
Address: S_�,r5). N(aGh _j) V?_� 1 , ewe � . 349 O�
Legal Description:
Property Tax ID#: -2 G 0 9 C) I O O 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to b e pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters \/<Window Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$�/ U j C� Utilities: _Sewer _Septic Building Height:..
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Name Sryxnnon no-c 1e4-e- Name: _ o
Address: s-ZeDst 2>('2-ch T)2 Company:
City: r-�p ey Pkp— e.ce State: Address:'
Zip Code: -34 Cl Fax: City: :-
=-State:
Phone No.--;z Gj� —2S" Zip Code: I
E-Mail: C'd , rr'� Phone No,,,,
Fill in fee simple Title Holder o next p e (if different E-Mail:
from the Owner listed above) State or ounty License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER ENGINEER: Not Applicable _.
DESIGNER/ENGINEER: PP 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 certifythat 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.
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 toy 0,11F A Notice of Commencement must be recorded and posted on the jobsite
before the first insp ction. If o intend to obtain financing, consult with lender or an attorney before
commencin co
rk or rd' o r Notice of Commencement.
ndidre o Ow er/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA f STATE OF FLORIDA
COUNTY OF COUNTY OF
The f rgo'ng instrum w acknowledg fore me The forgoing instrument was acknowledged before me
this C y of �t 20by this day of 20_ by
cs�_ka"V\' V\ C-1-A cc'�
(Name of person acknowledging) (Name of person acknowledging)
(Signature of otary blic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Kn �'�ar'"�: O I erjt'fication i Personally Known OR Produced Identification
Type of Identi a _uq Type of Identification Produced
Commission 4o. (Seal)ren"" Commission No. (Seal)
„allot#, .TNotar
REVIEWS ` '� p l a of FI RVIS0R PLANS VEGETATION SEATURTLE. MANGROVE
ERCa jnM1VA�F234 0.R IEW REVIEW REVIEW REVIEW REVIEW
DATE Foci�o°:`S:. YCo m.Expires May 27 2019
RECEIVED M,E 5 Bonded hroughNationalNot Assn.
�DATEPOMLETED
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