HomeMy WebLinkAboutBuilding Permit Application AII'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r ^�
Date: 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:
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Address: t -LLXI
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Legal Description:�� ����,�,.r� � 'Yf�P _ :ID c��(I iV a
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pertormed under this permit-check H tat appy:
Mechanical _Gas Tank Gas Piping _Shutters /-Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction:l2 3'1C 7.��� Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
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Name It--"
Address: /00 040 k4 4-0" Company:
City: �� State: Address:. . 'i o id{�rG' Rd
Zip Code: Fax: City: �6t-� _State:�L
Phone'No. Sc/ATL,/( 1946? Zip Code: Fax:
E-Mail: A/n-yi Phone N �
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
-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 job.site
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signafure of Owner/Lessee/Contractor as Agent for.Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing insttuq�ent was acknowledged before me The forgoing instrument was acknowledged before me
this A day of N-CX) s 2011 by this—day of 20_ by
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(Name of person acknowledging) (Name of person acknowledging)
--(Signature of Notary Public-State of Florida (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known—OR Produced Identification
Type of Identification Type of Identification
IPgd ed C) Produced
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Commission No. C 426 Commission No. (Seal)
LASHAHNAINGRAM
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E Ay Comm.Expires Dec 20.2018
79RINOon# -FS1UNRVI R PLANS VEGETATION SEA
REVIEWS iNNRVI 0 TURTLE MANGROVE
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0 joI3E.MIi11\*Natio lia!INMM REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
7/2014
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