HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CO- Permit Number:
RECER"-D JUN 2 '2216
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: To Select from dropbox, click arrow at the end of line yy�a
PROPOSED INIR,ROVEI EENT-LOCATION�
Address: �' ��� c � �
Legal Description:
Property Tax ID#: Gz0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF°WORK:
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CO"NS-TR.UCTIO;N INFORMATION
._
s
itiona work to be nertormed under! ispermit—check all appy:
HVAC Gas Tank DGas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
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Cost of Construction: $ �� Utilities: _Sewer Septic Building Height:
OW=NER/LESSEE . . . a CONTRACTOR:
Name -5uti df,-44 4446-M15 ~ FName: 4A1,J -,-s% f
Address: i 2"5-0/ /'rr0 lZ ` Company: —� C�) H �j
City: .f`` i�2v ir- State: /( Address: (A✓\
Zip Code:_ _ %4 Fax: City: r -�.��✓C� State:
Phone No. Zip Code: ��y/J 7 Fax:�,��� 9-T2-3
E-Mail: Phone No. ,?_22_
Fill in fee simple Title Holder on next page if different E-Mail: � j 0 ( x e U�t
from the Owner listed above) State or County License: Z
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 thepermit 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 propert A Notice of Commencement must be recorded and p ted on the jobsite
before the first inspe ion. If u int d to obtain financing, consult with lend r or attorney before
cork mmencin wor Eco n o Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contr or icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 'i—v r \ COUNTY OF Lt3e
The f oing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
thisa� day of �y,1� 20\G by this4.A, day of v J>_ 20by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PubTic-State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced4cle0 mon . Personally Known OR Produced Identifi. atio
Type of Identi kation EPtvNP of F`0 _ Type of Identifcatio ...! '
YP gta�e p16 yp DEANNA GIVENS
Produced L_ ., t'c X6'2 aP�` p lic State of Florida
pubExP�jeS Dec 5a�6t Produced t, 2:6 0''
} My Gomm i (�#Ea`NOtasy pss°•^ * _�My Comm.Expires Dec 16,2016
Commission No. ' m Commi45 eo EE 858761
Co c(` )�a�,on Commission No.
Bonded Through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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