HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application SEP ®g 2016
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:
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Legal Description:
Property Tax ID#: o7s �l��' T �� Lot No.
Site Plan Name: Block No.
Project Name: �!/i' �'/�i✓ ef`o C6f/�� ��t/vr'� �/� @��—�
Setbacks Front Back: Right Side: Left Side:
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AdditionalWork to be performed under this permit—check'all that appy:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
ectric _Plumbing _Sprinklers _;Generator _Roof
Total-Sq:Ft.of Construction: Sq:ft.-of First Floor:
Cost of Construction:$ JPa Utilities: —Sewer —Septic Building Height:
Name B bxly,4dr7e -e ktx A Name: G/2G%/l"%C C
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City:
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Zip Code: Fax: City: S State: F%
Phone No. Zip Code: Fax:
E-Mail: Phone No 3r
Fill in fee simple Title Holder on next page (if different E-Mail /-2 /l•�C ev.
from the Owner listed above) State or County License—EK
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1PPLEMN AL. CONS�TR±UCTION LIEN L.AV1/ INF®RMATION.
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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 posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or reco[ding your Notice of Commencement.
Signature of Owner/Lesseefcontr ctor as Agent for Signature of Contractor/Li se old r
STATE OF FL b; STATE OF FLORID - '
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COUNTY OF •?��», COUNTY OF - *', "'
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The f oing instru nt was acknowledged before $x<a The fo oing instrum nt was acknowledge before n X-a
this day of 2 1 V by 2 this�day of 2 _ by z M
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(Name of person acknowl ging) m gA (Name of person acknowledging _gvvA-T
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(Signature of otary Public-State of F rlcla U (Signature of I o ary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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