HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� f'��`b Permit Number: r O�
Building Permit Application
Planning and Development Services
Building and Code Regulation Division l
2300 Virginia Avenue, Fort Pierce FL 34982
,Phone: (772) 462-1553 Fax: (772)462-1578 Commercial -Residential
PERMiTAPPLICATION FOR: [�� ��10^ S �� �ie�, 2 0��
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Address: 6 r✓SSfiX A9C7
Legal Description:
Property Tax ID#: &32-- V05 - 6 d YQ - 000 - 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks. Front Back: Right Side: Left Side:',
R.
Additional Work to be performed uncle t is permit-check all that 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:$ V() • 00 Utilities: _Sewer _Septic building Height:
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�uE n eco r��ficTatir� -
Name (.Jr,+SON/;P� Name:
Address: 3 f
,�� GS�.e.�c. :�r--' �� '� Company: �.r-lS �,',.
City: Fl, Fere-e-, State: Address: /76 1 x':43 !K.4, `';� ..-
Zip Code: Fax: City: ��. �-es-r4 = Stater
Phone No. 172 3 SS -7 Zip Code: ItIc'N `1 Fax:.
E-Mail: Phone Nc( -)7 2j f a t ` -96 1
Fill in fee simple Title Holder on next page ( if different E-Mail
from th.e Owner listed above) State or County License 6 6
If'value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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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 with nder or an attorn efore
commencing ork or recording our 'ce of Commencement. I
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Signature of Owner/Agent/Les Contractor Signature of Contractor/L' Holder
STATE OF FLORIDASTATE OF FLORIDA '
COUNTY OF S�G� COUNTY OF &11Z::7 L� �_
The for to instru nt was acknowled e efore me The for m instru ent was a-cnowled d before me
this day of 20by this day of-_ 20by
IS OT\-
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(Name of person acknowledging) (Name of person acknowl ging)
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(Signature of Nott Public-State of Florida ) (Signature of Not r Public-State of Florida )'
ersonaliy Known OR Produced Identification Personally Known OR Produced identification
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REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER. REVIEW REVIEW REVIEW REVIEW REVIEW . REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 1