HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
IFIi l� li i� IUM ii Pi
1
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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:
Address: 1 C6
Legal Description:
Property Tax ID#: 14)os - ooLSV? Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work tobeperformed under this permit-check all that appy:
Mechanical _Gas Tank Gas Piping Shutters _Windows/Doors
_Electric Plumbing _Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
Name Name:
Address: Company:
City: li�_t' P�-C-f C.:c State: , Address:
Zip Code:�at)2� Fax: City: State:
Phone No. -)-6" ( Fk-p Zip Code: Fax:
E-Mail: -V Phone No
Fill In fee simple Title Holde 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.
DESIGNER/ENGINEER: Not Applicable MORTGAGE ANY: 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 proper l '* A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If yo end to obtain financing, consult with lender or an attorney before
commencing work or recording our ice of Commencement.
Signature of Owner e 6ntra for Ag,,—nt(��O her --Yig ature of Contractor/License Holder
STATE OF FLO STATE OF FLORIDA
COUNTY OF 'Sjr COUNTY OF
The forgoing in umen was acknowledged before me The forgoing instrument was acknowledged before me
this ") day — Ai Q, ---------J 20_L�o by this day of 20_ by
�nt 'o 0 her
(Name of person acknowledging) {Name of person acknowledging)
4ig qtuLre\\o_Sf�Notary Publit-State of Florida j (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (SeagHAHNAINGRAM Commission No. (Seal)
NotarY Public-State 01 Flora
4A-=
my comm.Expires Dec 20,2 1
comm ssion# n
REVIEWS FROM lw"Wedthr us@ . . LANS VEGETATION SEA TURTLE MANGROVE
COUNT E IEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED 77-
iev. 7/2014