HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
i'2- -I Permit Number:
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:
Address:u1
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Ilan -'lel- eaC11k3-- p16 -5
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
itiona wor to a pe orme under t is —permit- checK all tnai appy:
Mechanical _ Gas Tank —Gas Piping _ Shutters _ Windows/Doors
Electric — Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ q JC1y •oc
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Namel CA\ ►-t-1 N4Pu' 11
Address:�� �y
City: State:
Zip Code3Aq'5l Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Lurt(s So-�Orl S
Company: i A5-r[qm A el�s I ��
Address: Ile l 5 SE T' 6' "
City: State: �1-
Zip Code: 34 M Fax: 21a 33S ) iib
Phone No. 772 336 "3�-31
E -Mail: str 4, V U, 1'
State or County License: CA C 0 5 1 /O
if value of construction is 25eTor more, a RECORDED Notice of Commencement is required.
a Not
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: _
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 recorc;4g your Notice of Commencement
Signature of
Signature of contractorJLicense Holder
STATE OF FLORIDA - STATE OF FLORIDA
COUNTY OF 11_� Lo -eke CicCOUNTY OF CCI e �- � � I
The forgoing instrument was acknowledged before me The forgoing instr4ment was acknowledged before me
this I e_ day of 20_L� , by this i :' day of - 20 IV by
(Name of person acknowledging) (Name of person acknowledging)
(Signat re of Notary Public--Sto of Florida) (Si ature of Notary Public- a of Florida )
Personally Known OR Produced Identification Personally Known k11-1 OR Produced Identification
Type of Identification Produced Type of Identification Produced
ar a
Commission No.
N
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
DEBRA L * MYCOAMISSION NFJONE
DEBMLJOES75 Commission No. r � 1� *� * MYCO�� I ISSON
EXPIRES: September 5, ot:) EXPIRES: September
JSUPERVIS PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW