HomeMy WebLinkAboutBuilding Permit Application,,')PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
-1�; /1/,Permit Number:
Date:
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential
4ddress
Legal Description:
_ Lot No.__
Property Tax ID #: Block No.
Site Plan Name:
Project Name:
Setbacks Front__
Back: Right Side: Left Side:
Witionalwork to be pe Orme under this permit – c ec a t at appy:
Gas Piping Shutters _Windows/Doors
'Mechanical _ Gas Tank
Electric g
— P g —
plumbing _ Sprinklers _ Generator _ Roof
_ —
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Utilities: Sewer Septic Building Height:
Cost of Construction: $ —
Name lLr/ate
Address:
State:
f
City: U
Zip Code: ��p Fax:
Phone No. , rJ
E -Mail: Jr) /CJS / fiCr�� �7/YhCY�C F ClsYx'
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: LOrit5 Scan on S
Company: C"'T',t Air S�Sfems )iLG
Address: ((Q I S S� cl) r I D,(-
City:
�City: PC T Luc kL State:
Zip Code: 34�&l Fax: '�7; 33S 126X
Phone No. 77,1 33L -3�-3 2-
E -Mail: C 'fi r '4 v C`c ) ' cm
state or County License: CAC 0 5 )SIO
if value of construction isZ58�or more, a RECORDED Notice of Commencement is required.
7
i
Name:
Address
City: _
Zip:
Phone:
Not Applica
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone: _
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
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
structurin e. Pleasiecconwith
sult w with applicable
lome Owners Owners sociationtandon rrev rules,
your aws deed or any rrestrictions which may arict or p. prohibit such
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 recor(�iVg your Notice of Commencement q
Signature of Owner/ Agent/
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 31/ �G�Gc�e- COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 dG by this Lill— day of 20_ZZby
r u�PTr$ of'9AmoAs C�GG�T. IA0164'42(
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- at f Florida )
Personally Known OR Produced Identification
Type of Identification Produced
p Dry � .•• • �•; r CHRISTINE B. ENGL
C
Commission No.L f �7 07 * l MY COMMISSION# EE 8!
EXPIRES: April 4, 20
Bonded ThN Budget Notary S.
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
(Signature of Notary P ic- Sta of Florida) i
Personally Known I- OR Produced Identification
Type of Identification Produced
1PkPU
Lq� pp : ' CHRISTINE B. u
? �Ca J la1ca 1)My COMMISSION E^E 8592&
,commission No.
EXPIRES: April 4, 2017
SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW