HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETEDFOR;'APPLICATION TO BE ACCEPTED tt��
Date: Permit Number:
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
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PERMIT APPLICATION FOR:
JYCb,.*
Legal Description: ��Cian �I 1fPsfafes -- 310� "�
_—
90 T
Property Tax ID#: Jg02- 6 ag- CJS Lot No.
Site Plan Name: Block No.'
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be pe rmed under this permit-check all that appy:
_,_,Mechanical _Gas Tank �Gas Piping �Shutters � Windows/Doors
Electric rt Plumbing �.Sprinklers _Generator ( Roof
Total Sq. Ft o€Construction: Sq. Ft.of First Floor:
�ost of Construction:$ i' Utilities: Sewer _Septic Building Height:
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a e r f Name: 4
t
Address: ` -Company:
Cit1y: r . ��r �i� State: Address:
Z p Coded .�f�'"/� Fax: _ _ City: State:
one No. z7� Zip Code: Fax:
E-Mail: Phone No
ill 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.
SIF' LEMENTALC�NSTRCTION ). � LA1N �Nt�[ATIC}N'
DESIGNER ENGINEER: _Not Applicable Not Applicable
/ pp MORTGAGE COMPANY' _
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: 1.Phone!`
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City: I
Zip: Phone: Zip: ;Phone:]l',
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.
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St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build thei 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 rest fictions 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 lenderlor an attorney before
commencing work or recordingr Notice of Commencement.
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Si hafdre of Owner/tesseeC&ntraitor'-as gent for Owner Signature of Contractor/License Holder
SATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_` g ice_ COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this L4�_day of 201�o by this day of �. 20_ by
(Name of person acknowledging) (Name of person acknowledging)
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Jna ure of Notary Publi -State of Florida) \\ (Signature of Notary PublicJState of Florida)
Personally Known OR Produced Identifications Personally Known l OR Produced Identification
Type of Identification Type of Identification
Produced Produced
L C)o . ;W----,,q g-b
Commission No. u Commission No. (Seal)
euo�leN UBooiU{Pa U 9
Usstl R1¢loNl WOp
UOISSIW �.41
VAO
REVIEWS FR rZo<�► 14P419i'd" UFE �V1 PLANS VEGETATION 'I SEA TURTLE MANGROVE
COU l'�� W3�I�bllMSv� REVIEW REVIEW REVIEW REVIEW
IPP
DATE
RECEIVED
DATE
COMPLETED
Nev. 7/2014
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