HomeMy WebLinkAboutBuilding Permit Application All APPLICAB N O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: Permit Number: l
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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 L' .,//
PERMIT APPLICATION FOR:
PRO:POS:ED INI?ROuEMEN�OCATI'ON
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Address: `7 Sd 7
Legal Description:
Property Tax ID#: 13C-)/bU_A6 U�'� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE�T�AILE�® DE�S'CRIPTION�•OF WORK; x
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CONSTRUCTION INFORMATION:
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Additional work to be pertormed under this permit-checrall 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:$. C� Utilities: —Sew er _Septic Building Height:
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Name /)r:�ll,d Name:
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Address:-2-5-0-2 Company: /
City: R Ifi Ei P Cid Stater Address:
Zip Code: y 7 S � Fax: City: / State:
Phone No. ��� �,� Zip Code: --,,""Fax:
E-Mail: d"i i P'Lz")1 L ._ � Gr�M , ;Inv[� Phone-No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State orC-ounty License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Big' M, 5SILWRI /1tilFM ® ON ® :
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 thepermit 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 fecording yoyj Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA-
COUNTY OF �C� , 1 A C�,�� COUNTY OF
The f r ping instru lent was acknowledged before me The forgoing instrument was acknbwle ged before me
this r ay of 201a by this day of 20_ by
c'ic cA
1� 1t1�S
(Name of person acknowledging) (Name of person acknowled ng)
MAL Id
(Signa ure of otary P blic-State of Florida) (Signature of Notary ublic-State of Florida )
Personally Known OR Produced Identification Personally Know OR Produced Identification
Type of Identificati Type of Identifi ation
Produced " Produced
o ANGELA M HUFF
)XIA. Not Public-State of Florida
Commission No.
Com
#FF 234730
:Com7miss' n No. (Seal)
My Comm.Expires May 27,p019
Bonded
- ssn.
REVIEWS FRONT ZONING SUPERVI O ;/ANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW VIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014