HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:o.8,lI'6/2D/~Permit Number:_
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COUNTY .
FLORIDA --
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:To Select from dropbox,click here
Property Tax 10 #:2405 -501-00733 -COO-2...
Site Plan Name:_
Project Name:_
Lot No./3..;-/Y
Block No.Y
Setbacks Front _Back:Right Side:Left Side:_
app y:
ShuttersDGenerator
o Windows/Doorsri.,
Total Sq.Ft of Construction:_
Cost of Construction:$3q5D~
S~of First Floor:
Utilities:USewer DSeptic Building Height:_
Name.LtrM.
Address:company:lldvt1.rt/tJ4c 11k d..f.he treasure
City:r 7e t'State:EL-Address:~ON lCtarP,el tlJ!(IUI"C-
Zip Code:0Lfql/7 Fax:_______City:,::oRA-'Ptetl'e..State:Fe.
Phone No.'7'12-%0 -tfO,39 Zip Code:,iCf982.Fax:'T'7d-L/65-l/9lfS
E-Mail:Phone No.7'72-%5-1{d)~
Fill in fee simple Title Holder on next page (if different E-Mail:adtlOn+age.;ermd r@ho-fmtki /.CO/K..
from the Owner listed above)ate or County License:t!ite 039/dd1=1=-6
If value of construction is $2500 or more,a RECORDEDNotice of Comme
DESIGNER/ENGINEER:_Not Applicable MORTGAGE COMPANY:
Name:Name:Address:Address-:----------------
City:,..-State:City:~-------State:
Zip:Phone:Zip:Phone:_
".~,,:/
_Not Applicable
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 structurewhichisinconflictwithanyapplicableHomeOwnersAssociationrules,bylaws or and covenants that may restrict or prohibit suchstructure.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 flnanclng,consult with lender or an attorney beforecommencinworkorrecordinourNoticeofCommencement.
FEE SIMPLE TITLE HOLDER:_Not ApplicableName:_
Address:_
City:~-----------Zip:Phone:_
I ature of Owner!Agent!Lessee
~~J~T~~Fci~ORI~d LuCt~
The fo!s"oing instrupept wasLacknowled~efore me
this/~day of l'-1t:irt!,,-,20W byC30mue/I.-2J.1I rhll/lf
Commission No.__---=~--=:..-:--
Revised 07/15/2014
_Not ApplicableBONDINGCOMPANY:Name:_
Address:_
Citv;-:--_
Zip:Phone:_
Signature of Contractor/License Holder
~~~T~.:?Fci~ORIB/n1 Luc;c;
The f?~qing instrJ,lllJent was acknowledged before me
this I~ay of fI..«l~.20~by
c5an1f/e!'.{(I,i,
(Name of person acknowledging)
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(ignature of Nota;?b'-Stat~'(5 ri!t~.)*?~.~oc ••••••••y~;,~;:::"!::v ••'t,'l-I'IREs -,v-$;~
Personally Known o~~~;"~ntifiq\j~
Type of Identification ProducsLU i~::::,'C'%~'5E-z.!i!cg •l 21:•••••=Z.~:::l .•~s~.lU:::::.d:.~Q ~•.es 1:>S·I--~Commission No..~••~~;n (~~#•••~~.'P ~'<fS.~~_..~~.o·~~~~~
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