HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 02 acv Permit Number: ^ c`
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:
PROPOSED INPROENT
Address:
Legal Description:
Property Tax ID#: 0 b 3 d Lot.No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAI�LE® DE�SCRI'PTI®N G1F UVO�RK:
112
p I SV-
CONSTR�tJCTIaN IiN!F®Rall/l"ATION: `'
itiona work to be pert.ormed 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: S Sq. Ft. of-First Floor:'
Cost of Construction: $�9b6 Utilities: —Sewer _Septic Building Height:
®UIt
�N,,ER/ 5 "E: C®NTRAC1"0'R:
Nam l .+�
Address: S ,V- P, .Z�� . .3 Company: '� �,cw e.'
City: 2 '�✓2 State.,FZ� Address: /
Zip Code: J�� Fax: City: , ,'ielec ii- State;p__ =
Phone No. �� �{Q� Zip Code: 7 1/� 5' Fax:
E-Mail: Phone No ��S-
Fill in fee simple Title Holder on next page(if different E-Mail c•4 4 a✓e-�
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
StJRPEMENT/��L CONS R�tJC"�T'I`DN LLEN !_A�UN IN:F®R11/IP►1' Q ,� ;.
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 recording our Noti5q of Commencement.
Signature of Owner/Lessee on ct r as Agent for Owner Signature C ntractor/ ' ens e older
STATE OF FLORIDA �� � FLORIDA
COUNTY OF COUNTY OF 'SA�
The forgoing instrument was acknowledged before me The fgLgoing instrurgent was acknowledg fore me
this-.1 day of 20 y this y day of /n0_" 20 y
LOK:1)_� ck— f-"� - �9�_
(Name of person acknowledging) (Name of person acknowledging)
N (__� Al\ Q�e A
LA
(Si of Public-State of Florida) (Signa ure of Notary ubl' - of Florida)
� .NUtARYei
Personail
1i,PRY a': O d Identification P sonally Known = rl� fce tification
Notary P bGE�A M HUFFT e ion " N01,Produced `<1 ` > comm lic Stat Produced C_yp6b�! �qM
-?. Y Coia ��lflMtn. orlda �. B y�om ISs�oo
Commission No. , hen"�rm�u�hparhonMaY2g1 9 Commission No. o°dedlh { eFF?34StatyUFF j�orida
alNotAssn, 9hNalio�aMNy�7 20
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MAN VE
COUNTER REVIEW REVIEW REVIEW 'REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 4