HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE PFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
RECEIVED APR 0 8
2016y
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 Z�<
PERMIT APPLICATION FOR: v
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Address:
Legal Description:
Property Tax ID#:. �51� Sd�— a-s C3GG- Lot No.
Site Plan Name: Block No.`
Project Name:
Setbacks Front Back: Right Side: Left Side:
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2=1011-1beperformed
[N�FRMATIQN � � �., . � `under this permit-Check all tat appy:
_Mec anical _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: $ (3 6 Utilities: _Sewer _Septic Building Height:
Name Name:
Address: ekT j6X Company: &2
City: State;W Address:
Zip Code: .� Fax: ,� �� City: State:z Z
Phone No. Zip Code: Fax:
E-Mail: / , Phone No�77�
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
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.
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.l 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 recording our Notice of Commencement.
nature o caner/Lessee/Contractor as gent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Sk, LUCOUNTY OF
The forgoing instrument as acknowledged before me The forgoing instrument was acknowledged before me
this 4 day of 20_�G by this day of ,20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pubh-State of Florida) (Signature of Notary Public-State.of Florida)
41
Personally Known OR Produced Identification,` `v7 Personally Known OR Produced Identification
Type of Identification P GIVENS F10��da Type of Identification
Produced fl k-- DEpN Sake Produced
'��'�; No�a�`1Pub``xP��es�ea5a�61
Commission No. $. avowll Ps _.:;Co
V mmission No. (Seal)
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REVIEWS FRONT,�,,,,V "ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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