HomeMy WebLinkAboutBuilding Permit Application All APPLICAB4 INFO 4LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ��
Z—fDate: L' 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
PERMIT APPLICATION FOR:
PROP®SEDT[N� �/E11/IENT.L®_ CATI'ON: a r
; 4 .
Address:
Legal Description: f D U s<
Property Tax ID#: ►/ 3� l �r l Lot No.
Site Plan Name: rlv► u c/ s� A �' Block No.
Project Name: 14/!l u CZ Se h 7' '1 C !6t Q
Setbacks Front Back: Right Side: Left Side:
� DETAI4LED DE�SCRIP� � � � a
TION OF V.1'l®RK�
P,-e-Pe f -- V _ Wit— ` -
�-
MNSTRUCTION IN'1=®RIUTATCO:N: ,
Additional work to b be performed under this permit—check all that appy:
_Mechanical _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: $ �iy vv . — Utilities: _r Sewer _Septic Building Height:
OU1/NER/13ESSE C®NTRA01®R: ¢
Name 116C)4- 56- `D rd l cL Name:
Address: Company:
City: �or �/��,rt� Statesee Address:
Zip Code: Fax: City: State:
Phone N/.--2 7--_2 321 — -9,6-0 Zip Code: Fax:
E-Mail:}5 h I zl5-t/1 1 0 6 //58L- L-• /Lc- Phone No
ld
Fill in fee simple Title Hoer on next page( if different E-Mail
from the Owner listed above) State or C my License
If value of construction is 2500 or more,a RECORDED Notice of Comme cement is required.
SUP'PLEl1/IE.NIAL CONSTRU�TI"O'N LI' N LAW INF®Ilata :
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
befor a first inspection. If you intend to obtain financing, consult with lender or an attorney before
cpr6meneing work or rVcording your Notice of Commencement.
D c�
Sig ature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA c ` STATE OF FLORIDA
COUNTY OF J� �G 2__ COUNTY OF
The f ing instrum nt was acknowled a efore me The forgoing instrument was acknowledged before me
thisoday of 20y this day of 20_ by
(Name of person acknowl dging) (Name of person acknowledging)
(Signature of Notij
Public-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi 'i Type of Identification
Produced- •""""••., ANGELA M HUFF Produced
otary Funlic-State of Florida
Z. ;•= Commission FF 34730
Commission N � ��e� Commission No. (Seal)
, mm.Expi es y 27,201
Bonded through National Notary Ati,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.