HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ ,.,.. NOUN' Building ppPermit A lication
,
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
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PERMIT APPLICATION FOR:
PROPOSED INRR01/EME T LO ATION F �'"'" °
'`.a a Y"
00
Address: le—s'.1,i! la-Ou
Legal Description: I
Property Tax ID#: Dom. 0 G Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DESCRIPTION OFIUORKu
1 :2
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CONSTRUCTION INFORMATION , i
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x
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters W' ows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
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Total Sq. Ft of Construction: ` 00 Sq. Ft.of First Floo is 1
Cost of Construction:$ Utilities: —Sewer _Septic i Building Height:
OWNER% SSEE CONTRAC R
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Name 1 11 Name:
Address: SA& Company,- w
Cit y/V State: ddr 1 ��/
Zip Code: x: City: GI: ! State:
Phone No. ✓ Zip Code:s Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ',�
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Ap able MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: ZP6
e Zip: Phone:
FEE SIMPLE TI TtE HOLDER: _Not Applica le BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Ph o Zip: one:
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 thaf.is,granting.a permitwill authorize the permit'holder to build the-subject structure
which is in contljdt:with.a6y-applicable Home Owners Association,r.ules, b laws or and covenarits.that may restrict,or^pro`hibit such
structure. Please consult with your Home Owners Association and`reviewYyour deed for any I estrictions 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 lender or an attorney before
comme work or ordin I g your Notice of Commence
Si nature of ow q r/L see/A ent Z94XITE.'OF
ture of Contra to Lice a Ho r
STATE OF FL RIDA FLO:R D
COUNTY OF \ • COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledg d before me
this day of i iVA a 20 by this day of��tlNa� 20 ;S by
7(NamXfrson ac ledging) (Nam persona owledging
\, natur of Notary Public-State vlorida) (Si toa of Notary Public—Stat ' f Florida)
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Personally Known OR Produced Identification Personally tnp�w- OR Produced Identification
Type of Identification Type of Identification
du ed. .
Produced � Pro4 _ .°. .... � __.f.�._...
Corhmission_No. - .(Seal) , Comrnission:No. (Seal)
REVIEWS FRONT ZONINGSUPERVISOR PLANS -VEG,ETATIO.N,''.. SEA TURTLE MANGROVE
�. COUNTER. REVIEW' - REVIEW REVIEW ' REVIEWREVIEV1f `:` REVIEW
DATE
,RECEIVED `
DATE .
COMPLETED
ev.7/2014