HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO ST EkE
(COMPLETED FOR APPLICATION TO BE ACCEPTED
IrDate: a 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: pV�e
PR 'P .SED Ph' 1111E ,T �: A
Address: ® S .3 '� �C 1e�C� 3qCNI
Legal Description:
Property Tax ID#: � �% t �7�—��0 Lot No.
Site Plan Name: Block No.
Project Name: 1 �Dy5CRQC&
Setbacks Front Back: Right Side: - Left Side:
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Additionalwor to be pertormed under tis permit-check all t at'app y:
—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:$ Utilities: —Sewer —Septic Building Height:
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Name � V p-- /13
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Address: i Company:
City: 40 v State: Address:
Zip Code: IFax: City: State:
Phone No �40 -, �� Zip,Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mai
from the Owner listed above) S e or County License
If value of construction is 2500 or more,a RECORDED Notice o Commencement is required.
SUPPLEME'NTAC CONSTRUCTION LIEN LAW INFORMATION:
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 hold"er 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 ob cing, consult with lender or an attorney before
commencingwork or recordingour Notice o Com a cement.
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g furreb Owrter/ s`see/Agent =o�a -Signature of Contractor/License Holder
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TATE OF FLORI oa STATE OF FLORIDA
COUNTY OF ¢�'� d COUNTY OF
C§
The forgoing instr ent was acknowledged befo , Ie°";;., The forgoing instrument was acknowledged before me
thi day of 20L5—by r4g=� this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature ofoltary Public-State of FI ida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of ent i n Type of Identification
Produced Produced
Commission N (Seal) Commission No. (Seal) .x
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014