HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST IfE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
wr
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce F!34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential i
PERMIT APPLICATION FOR:
Address: / �' �lt2t=s JCcc} m
Legal Description:
Property Tax ID#: ' '/0' OW Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
itio work to be pertormed under this permit-check all that apply: —
Mechanical _Gas Tank —Gas Piping i Shutters Windows/Doors
_Electric _Plumbing _Sprinklers —Generator Roof
Total Sq. Ft of Construction: / Sq. Ft.of First Floor:
Cost of Construction: $ c>f (100 Utilities: _Sewer _Septic Building Height:
Name Name:
Addres : 0 ke ✓ Company: err' {
City: 2 State: 1"' Address: <d &';`1 t''ll
L42-
Zip Code: y � Fax: City: e P State:��
Phone o 7 O Zip Code: Fax: /
E-Mail: y4e Kijobe Y. Phone N '7
Fill in fee simple Title Holder on next page (if different E-Mail ao it-
from
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.
1�10ture of Owner/Lessee/Ccffractor as Agent for Owner A gn ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF !r•l•. 'X_a COUNTY OF S► I.Xpn o
Theforgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this g day of 20 16 by thiso`ZS day of 20& by
TNamf of person acknowledging) (Name person acknowledging)
(Signature of Notary Public-'S'tate of Florida) (Sign e fNotarv�P ubl�,tatlorida)
Personally Known OR Produced Identification' Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) .Commission No. (Seal)
A MGRAM
State of o LASHA
1PaY°�e�'•, ry Pu IiC ��,Q> St t i Florid?
REVIEWS FRO _:_» omm.F 'q PLANS VEGE T" ';S�t�I nes 0f*ROVE
COUN w
Aom�i �REVIEW REV 1l: =NAE4PIL"(11/E.p #FF1gtMtEW
p» J�
DATE ;f a m �' h Nati nal Notary
Bondedthroug
RECEIVED
DATE
COMPLETED
Rev. 7/2014