HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST EfE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:� (}0"�"rJ "
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fart Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: 16,('? S1714 � � ✓`/t/E'� f
Legal Description:
Property Tax ID#: l l " Y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
7 J:frc-
titin I work to be pertormed under this permit—check all that appy:
Mechanical _Gas Tank _Gas Piping —Shutters Windows Doors
_Electric ,Plumbing Sprinklers —Generator T Roof
Total Sq. Ft of Construction: / �� Sq. Ft. of First Floor:
Cast of Construction:$ doe Utilities: ,Sewer Septic Building Height:
Name Name:
Add-rel: 0 SS– S ✓ Company: �,rr
City: ' State: f^ Address: t� A' Y`ll
Zip Cade:M3 Fax: City: vem Stater
1<50
Phone o(2 aZ Zip Code: Fax:
E-Mail: c4� mcc4 e Phone N 7 16
Fill in fee simple Title Halder on next page{if different E-Mail t oa. G aim?
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 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.
ture of Owner/Lessee/Coffractor as Agent for Owner g ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1.�tc,.a _ COUNTY OF Vic`o
Theforgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this Oday of 20 Ib by thisc9S day of 20& by
1
(Namf of person acknowledging) (Name#person acknowledging)
(Signature of Notary Public- ate of Florida) (Sigrikde 8f Notary Public-Stat f Florida )
Personally Known OR Produced Identification' Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) ,Commission No. (Seal)
AINGRAM
0
tPay'�s�• Public-State o I LASHA t t t Fionde
REVIEWS FRO =2. Y
�omm.ESdi1Pf! PLANS VEGE "a,• fl�tV1 'LXpires D ti1ROVE
COUN «* I om,ni sie¢Z - EVIEW REV H17'•'` \;;4"o•c N Pf 1/E. #FF 1� tEW
DATE a ' t � Bonded through Nati nal Notary
RECEIVED
3
DATE
COMPLETED
Rev.7/2014