HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR,APPLICATION TO BE ACCEPTED V .n/�
Date: Permit Number: 1 (Q V 5 ocqs
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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:
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PR IF POSE_D INR' EI'IEN
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Address: 5-30-5- /e o V •�jc s Z.rc.&
Legal Description: e�dC� U'�esc- 355-
Property Tax ID#: 000- 2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CO�ISTRUC� ION INfORMATfON Eta 5fi�#"ti r
Additional wor to be pertormed under this permit-check all tatp y:
_Mechanical _Gas Tank _Gas Piping hutters _X,Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction- Sq. Ft. of First Floor:
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Cost of Construction: $ �� Utilities: —Sewer —Septic Building Height:
3'�F ON'TOUNERLESSEEfACgTer O,r
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Name Asa •wa Name:
Address: 530 ' Company:
City:F Q'cic c State: FL Address:
Zip Code: 3Y55-1 Fax: N44 City: State:
Phone No. 77.2- ;216 - Y S51- Zip Code: Fax:
E-Mail: Q Phone No
Fill in fee simple Title Holder 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'PL.EM;EN�T;AL CONSTR CTI®N. LI'E�N 1J1U1J 1NF®R�11%IA�T OWN r ���° �� � � �=
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 Notice of Commencement.
Sign re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA J ' STATE OF FLORIDA
COUNTY OF `C> , [--�� COUNTY OF
The fMoing instrume t s ackn wledg� efore me The forgoing instrument was acknowledged before me
this-::) day of \J` 20 y this day of 20_ by
(Name of person acknowle ging) (Name of person acknowledging)
(Signature of NotadPublic-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Kn,�,, rlwoft ,,, tif* ation Personally Known OR Produced Identification
Type of Ident' No r ANGELA M HUFF Type of Identification
y _ Public-State of Florida Produced
Produced !a . •=
Q- on#FF
�F; MY Comm,Expires 234730
Commission No... Bonderifn� Mp.2019 Commission No. (Seal)
�} ,,—.k.+• � ugh National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014