HomeMy WebLinkAboutBuilding Permit Application.PP ,LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J 1�9-/� Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Building Permit Application
Commercial Residential
Al" -- �'�'n/fg'-QQQ-'( Lot No.
Property Tax ID #: �/
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Uk
pitiona I work to a pertormea un er Ll I is permit - c ec a t at app y:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Windows/Doors
Generator — Roof
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name '�f!"et 7�1
Address: &"/I&! �ir�b���2 4A
City:
City: "OAli .it State: f�l
Zip Code: v'Fax:
Phone No. -
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: �urti5-So,ynr on -�
Company: C,us -P nrn A t'( -
Address:
(-
Address: � ( IS S �- Ti r\ Dr
City: Vo -T � Luc kf State:
Zip Code: 34 �-SL Fax: '17a
Phone No. 77,2 33,S -32-32
E -Mail: C 'fig r CLC
State or County License: CAC 05 Lx( S�Q�
If value of construction is 2,sem 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 with lender or an attorney before
commencing work or recor ' our Notice of Commencement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA ,v
COUNTY OF �f��
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this -aday of M �re<v 20_ by
this.:', ' day of M A QL4 rf 201 e by
Cg plTis AM M IA?1_�
T� S rn P'S
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- Stat"f Florida)
(Signature of Notary Public- Stafe of F ida )
Personally Known OR Produced Identification
Personally Known - OR Produced Identification
Type of IdentificationProduced
Type of Identification Produced
/
Commission No. L� l %` (Seal)
Commission No.,!�-7CO s aT � (Seal)
i
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
i
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. /2014