HomeMy WebLinkAboutBuilding Permit Application,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit Number:
Building' Permit Application
C/
Commercial Residential
Address:���
Legal Description:
Property Tax ID #: J7�� Lot No.
/�����T�� �
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Total Sq. Ft of Construction:
Cost of Construction: $ G
Name /ut
Address: State: -
City: L
Zip Code: ���oZ Fax:
Phone No. %72" ��� >�t53
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Ft. of First Floor:
Windows/Doors
Building Height:
Name: �Urtl5 Samrnon S
Company: rias -rL iia Lc SSS ieynS I1U G
Addresss: 1l I S S& N i I (04L4 r r� D,
`�
City: re ST Lti c k e- State: FL
Zip Code: 34 �-&2, Fax: l7a 33S 1 ct6
Phone No. 77- 3L-L-32-
E-Mail:
L-L-32-
E-Mail: C U 'fi ,- Sq
State or County License:
If value of construction is 2y9�or more, a RECORDED Notice of Commencement is required.
It
Not Applicable
Jame:
kddress:
:ity: State:
NP: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zi • Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: State:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: -- Phone:
P•
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 ,bylaws or and covenants thatt may restrithe ctborproct hibits ch
which is in conflict with any applicable Home Owners Association rules,
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
agree that I will, in all respects, perform the work
In consideration of the granting of this requested permit, I do hereby
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
end to obtain financing, consult ith lender or an attorney befe recorded and osted on the ore before the first inspection. If you Int
commencing work or recor ' our Notice of Commencement. r, A
Signature of owner/ Agent/
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledgbefore me
this 9, day of .Loc �i 20 by
«'vi%S
(Name of person acknowledging)
(Signature of Notary Public- St a of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
p A2` ' yea dy COMMISSION # EE 8592f
Commission No. �� 9 U) EXPIRES: April 4, 2017
Bonded Thor Budget Notary Smk
Signature of ContractorfLicense Holder
STATE OF FLORIDA
COUNTY OF n1 ✓ C'
The forgoing ins7----
ent was acknowledgedbefore
by re me
this day of
(Name of person acknowledging)
(Signature of Notary Public- State of orida )
Personally Known OR Produced Identification
Type of identification Produced
�o � .,.•e`� EWGLISH
Commission No. t?YY COMMISSION OMMISSION#EE 859284
EXPIRES: ADM 4.2017
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