HomeMy WebLinkAboutBuilding Permit Application,?P.LICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date:
_�� /� Permit Number:
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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
Property Tax ID #: o��`��lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: left Side:
litional work to be pertormed under this permit- check all that apply:
Mechanical _ Gas Tank _ Gas Piping _Shutters
_ Electric _ Plumbing — Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Z Utilities: _ Sewer _ Septic
Name6Q./4& (/X)
Address:
City: / ,c 22�`Z State: f
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
!yS
Jo/tL✓
Windows/Doors
Roof
Building Height:
Name: Curtis SaY� �n
Company: (,us T.�L'c �, S fe inS
Address: t( I S 5�- T i I l' Di-
City:
r
city: Vc, a -r � T L k c � e - State: FL
Zip Code: 34SL Fax: 77a 33S I �
Phone No. 77,2
E -Mail: C 'fig r � Ctic)
State or County License: Cfl C 0 5 �{ 10 Sae
If value of construction is 2 or more, a RECORDED Notice of Commencement is required.
t
Name:
Address
City: _
Zip: _
EER: — Not Applicable
Phone:
FEE SIMPLE TITLE HOLDER
Name:
Address:
Citv:
Zip: Phone:
State:
Not Applicable
MORTGAGE COMPANY: — Not Applicable
NamP.
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
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 structuin re. Please consult any applicable
Owners Association and review your deed or or any esti ctio s wn cn ay aor l. prohibit such
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 recoroiVg your Notice of Commencement 1 1
Signature of Owner/ Agen
Signature of Contractor/License Holder
STATE OF FLORIDAQ STATE OF FLORIDA
COUNTY OF JI'A ee_C' COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L' day of 20 by this _ day of 20_ by
�zez/7�flrn M X
✓-S-
1,UIU �5 �� ,n S i S
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public State lorida )
Personally Known OR Produced Identification
Type of Identification Produced
�� MY COMMISSION # EE 8
Commission No. * Ij« EXPIRES: April 4, 2i
s, ° Bonded TAN Bodo WAry
(Signature of Notary Public- State�of Florida )
Personally Known '/ OR Produced Identification
Type of Identification Produced c H
H p �dY COMMISSION # EE 85928,
1ommission No.ElYsy��y `^ 1/ EXPIRES: April 4, 2017
Ma '°rf oc F�cR� Bonded Thru Budget Notary Service
REVIEWS FRONT I CO NTER I VIEW I ONINGS REVIEWOR I REVIEW
PLANS
DATE
RECEIVED
DATE
COMPLETED
VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW