HomeMy WebLinkAboutBuilding Permit Application All APPLICA LE INFO( MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Permit Number:
u
Building Permit Application
p)onning and Development Services
Building and Code Regulotion Division
2300 Virginro Avenue,fort Pierce Fl 34982.
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT A,PPLl TION FOR
a°�..a,.
Address:
Legal Descri tion: .4�`t �=
Property Taix II? .... Lllc�D r C�P Lot No.
Site Plan NO me: Block No.�r
Project Name:
Setbacks Front .,_ Back: Right Side: Left Side:
1 k% :. I WI-3p-1u
'>�.. x `.9"1 A
a s,, r_ v,� • _ ,. w � xr.<.<� � ���
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rttona wor to be performed under this permit—c ec al that appy:
Mechanical _Gas Tank Gas Piping —Shutters Windows/Doors
_Electric Piumbing Sprinklers 4 Generator Roof
Total Sq. Ft of Construction: Sq.Ft.of First Floor: R gg
Cost of Construction $ 4`i,,3o oo Utilities Sewer ,Septic Building Height
Name ani it; �t3 _ Name: i
Address: " t` 1 i _ Company: 7Y7 t n
f i
city.— �{" L f� L � State: C'l - Address:
Zip Code -tct 5"'P Fax: .. -- "__'"" City " �� 1 ��'r lie v t�State,-
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Phone N b Zip Code: ?2 g'91.1' ._...._ Fax:('2'f �a &qQ
E-Mail: - --------- Phone No.
Fill in fee simple Title Holder on next page{if different E-Mail:— + Y-4
t f
from the Owner listed above) State or County
i
if value of1construc'tion is 2500 or more,a RE£t7RDED Notice of Commencement is required.
r _..............._..... . _.....__._.
CUP
-6ESIGNER ENGINEER' _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
EEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: game:
Address: Address:
City: City.
Zip: Phone: Zip: Phone:
OWNER/G,ONTRACTOR 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 Coup*,y makes no representation that is granting a permit will authorize thepermit holder to build the subjects;ructure
which is in conflict with any applicable Home owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Phase 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)will,in all respects,perform the work
in accordanc1 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 roams and accessory uses to another non-residential use
WARNINGITO 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 o r Notice of Commencement.
5gnatureOwner/Agent/Lessee i signature of Co or/License Halder
STATE OF, LORIDA STATE OF FLORIDA
COUNTY
OF COUNTY OF i-L_t-i *e_ ,
The fo,rP,oing instrument was acknowledged before me The forg,�ing instrument was acknowledged before me
this��ul�^da of 20AI by thi day of 20JU by
i
(Name of person ac ' ' l (Name of pets ackno
?b
(signature�nown
of Notary Public-State of Florida) ( ignatureofNotaryP6blic-Stateof Florida)
Personally r �` sonally Known y
�N�Y r��4
Type of Identification Prod .ed,a.m SHAWN A RUSSELL T e of Identification Produ et�J�*R u ' Notafy rid
Notary Pu c• a 1 F1or da
mission�+ff 95893 ,= Co (nlWon it fP 956989
Commissio No. (SeS�T mission No. � A10M.Expire Mtr 11i,20
My Comm.Explies Mar 11, 0 Bandied tluouphllatio11111, MY Ass
Bonded through Natlonal Notary ssn.
REVIEWS FRONT ZONING i SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
. —..._......._.
DATE —
RECEIVED — —
DATE l
COMPLETED
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