HomeMy WebLinkAboutBuilding Permit Application All APPLICABLEJ INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 16 No
14
Building Permit Application
Planning an Development Services
Building and Regulation Division
1
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)1 1462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
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Property Tax ID#:0 Lot No.
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Site Plan Name: Block No.
Project Namej or" &+ad,
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k ll itional workto be performed underthispermi athat-apply:
—Mechanical Gas Tank Gas Piping —Shutters Windows/Doors
Electric _Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: 0 go Sq. Ft. of.Furst Floor:
Cost of Construction: $ 0 Utilities: —Sewer _Septic Building Height:
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Name tcove ?16Vtl17 10(21'r;1 Name:
Address:0111zo R,QY1# I P;44fl Or- Company:
City: � 0-0 CT- -Ke,,P–CV- State: Address:
Zip Code: 54792, Fax: City: State:
Phone No.
10 7-!5—-2 7 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple
imple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
�S J�PRL�I\II,f�N-fAL.CONS`�TRtJCTION.�II'E'N LAW INiFflRfUlA1�l0N'.
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 proFiibit 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.
Signature-of--Ownerj Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA i•.E:'*:�o;•.: STATE OF FLORIDA
COUNTY OF �= COUNTY OF
The forgoing ins ent was acknowledged befor The forgoing instrument was acknowledged before me
this day f 20 by X� this day of 20_ by
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(Name of p rson acknowledging) 9- iE (Name of person acknowledging)
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(Signature o Notar ublic-State of Florida (Signature of Notary Public-State of Florida)
Personally Known OR Produced IdentificatiorT____� Personally Known OR Produced Identification
Type of I ern ' ication Type of Identification
Produced C Produced
Commission (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED -
Rev. 4