HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Jp b Permit Number:
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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:
4PROP�S;ED 1N ®1/EMENT L®CATION
Address: 0cm i e—
Legal Description:
�'. /d s 3.r GG
Property Tax ID#: ® f7 1 d :2 6an .7 Lot No. 2.
Site Plan Name: c� Block No.
Project Name: f�� / ��
Setbacks Front Back: Right Side: 0 Left Side: C1
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COSTRUC""TIO' INFORMATION x.
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Additional work to be pertormecl uncler this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: 41ir Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OUNER%LSSEE:
TRA
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Name Name:
Address: st ZD Company:
City:—fie State Address: ��� .n .J�
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Zip Code: FaxQ: Q City: �f ��;rrze State:
Phone No.� / 7,L / o G c Zip Code: ��&.L Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail 6 Na 4n,, /, co
from the Owner listed above) State or County License 7D�
LIf value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP`P'LEM,EIUI'AL CO'N�STRiIlCI'I'C7N LIEN .LAW INFtJRMATION
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 poste n the jobsite
before the first inspectio . If you/intnd to obtain financing, consult with lender or an tt ney before
commencingwork or re o in a r Notice of Commencement.
Signature of Owner/ es a/Co tr ctor as Agent for Owner Signature Con(ractor/ cense Holder
STATE OF FLORIDA I. f STATE OF FLORIDA � %
COUNTY OF C�� ~��� COUNTY OF t_Y� L�.� �
The f r oing instrume was acknowledged before me The forgoing instrum t was'acknowledged
,Wore me
this May of �� 20_../ay this�ay of 20 y
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(Name of person acknow)edging) (Name of person acknowledgi )
(Signature of N ary Public-State of Florida) (Signature of Notary ublic-state of Florida}
PersonaOR Produced Identification Personally Known OR Produced Identification
Type ofyy�'dR on Type oflde•t' is i
Producer* .°`�, '— AN6E Produ''",,,kp,
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DATE Ssp
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