HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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
PERMIT APPLICATION FOR:
APRCP _ _u Mu�54O- P N ad VIrf
Address:Dor) �n 2VNISL000)
Legal Description:
Property Tax ID#: 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Iff,�AILED DEtS-RIPTMN OF 1N®RK:.
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1175>4
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Additional work to be performed under t is permit-check all that apply----
-Mechanical
ppy:_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers —Generator _Roof
Total Sq. Ft of Construction: Sq.Tt. of First Floor:
Cost of Construction: $ c2600 ,00 Utilities: !—Sewer _Septic Building Height:
OUIfNR=/LESSEE: ®NTA1'®R: ---------------
Name--\ Name:
Address: OO-P fK'a ne)6) 7)vi Company:
State`s Address:
Zip Code: -:�49-T Fax: City: State:
Phone No."113- 98 a g 82 (ocl Zip Code: Fax:
E-Mail: it DN (P y Q !3-u\-Cc✓'n Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or Co ty License
If value of construction is 2500 or more,a RECORDED Notice of Comm en ement is required.
S�IJPPLEMENTAL C®NST RtJ TI®N t�FEN LAW ARM,, TI®Irl:
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 mother 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
commenc' ork or recording our Notice of Commencement.
Sig -re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA. Lr ,�_ STATE OF FLORIDA
COUNTY OFu -c I COUNTY OF
The fgrgging instrum n was ack owledged before me The forgoing instrument was acknowledged before me
this_day of 20-1 - this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
I�
( ignature of Not Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identi ' ti n Type of Identification
Produ P,id r. I A Produced
1 �pYPV-
0 B� -; Notary Public-State of Florida
Comcommission#FF 234730((g Commission No. (Seal)
Nr +ar My Comm.Expires May 27.2016 )
Q
-''%-of K, Ronded throw h National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4