HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: DDQ_" ()J4
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:
Address:
Legal Description: Ii ek &e4<, VN c i `"C lL -i 1 l.-o c -zO
PropertyTax ID#: 34 " Iq - :53 ' 010 '-.?-D - 0 -OD Fl Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional workto repeHormed under t is permit-check all tat 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:$ 00 D Utilities: —Sewer —Septic Building Height:
n
Name
Name:-F—( dt c'hv- -i 1vJ4- 1 o(?-P
Address: tI_ L:_ 61qr,q.4 ,::V JL_ Company: T-L`Ff-_ F-cS40-%__
City:i?_ 5 _(-- State:Pi- Address: 4133 13 02n1 S f4
Zip Code: 3 c(q 3 Fax: City: ` c.uh (�,cc� GSD 0-'JS Stater-
Phone No. _'54 ( - 6-)A?- 4 77 P Zip Code: 33 L( 10 Fax: 5-6(- 91 _0 71 P
E-Mail: Phone No 6 1 - -f 71�-
Fill in fee simple Title Holder on next page (if different E-Mail 5-,e P P F) 4,1a_Coa-('&Aci i-J6- - h efi
from the Owner listed above) State or County License C&-C, (5-0 5-1+7
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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 w
I lender or an attorney before
commencing workpr recording our Notice of Commencemen .
finaai2r=eAof'Owner/Lessee/Agent Signature Ufo tractor/License Holder.
STATE OF FLOgIDA /�, STATE OF FLO1�,D
COUNTY OF fJ s COUNTY OF
The forgoing instrurpent was acknowledged before me The forgoing instru e t was acknowledged before me
this day of 20/b by this Iday of 20* by
(Name of person acknowledging) (Name of person acknowledging)
�1111_vl3v'
L54natur o Nota ublic-State of Florida) (S' t of y�Public-State of Florida
( )
Personally Known ` OR Produced Identification Personally Known /` OR Produced Identification
Type of Identif catjw;,�B.,, Type of Identification
=o ,..A,��:; SARAH BROOKS-HERB JOYCE M.BECKER
Produced Produced MIRYA,
_ my UOVIVITUSIUN#FF153789 ` `fo NOTARY PUBLIC
�' STATE OF FLO
Commission No. ''FgF�°P'` EXPIRES Aug ? ,2018 Commission No.� �� ,, (S@@I)
(497)398=9153 Floridallotary8ervice.comd- Comm#FF168798
00 is Expires 10127i2''113
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DATE
COMPLETED
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