HomeMy WebLinkAboutBUILDING PERMIT APPLICATION-PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
9/� Date: Permit Number:
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce F! 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
)ERM IT APPLICATION FOR:
address:
-egal Description:
Property Tax ID #:
Site Plan Name:
Building Permit Application
Commercial
Project Name:
Setbacks Front
Back: Right Side: __ Left Side:
Residential
Z. l l Z Z , { j j ` j T� / SrP G/�p r5 e- D
Lot No._
Block No.
Mechanical _ Gas Tank _ Gas Piping
Shutters
Electric — Plumbing _ Sprinklers _ Generator
_
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
�6Utilities: _ Sewer _ Septic
Cost of Construction: $
Name ill
Address: lepiu
City:
State:
Zip Code: s Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: ( Ucbs S0 m 0n S
Company: ckA -'m r ��TS fe ims IN G
Address: IS SDr
n
City: t'c 2T ST Ljkc ti e r State:
Zip Code: 342JSL Fax: TU 33S 1 �ti,
Phone No.
E -Mail: C. 't4 r �4 1 ac j
State or County License: CAC 0 5 )RIO
S}a te
If value of construction is 2S9dor more, a RECORDED Notice of Commencement is required.
It
DESIGNER/ENGINEER:
Name: _
Address:
City: _
Zip:
Phone:
— Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
State:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
Citv-
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
structure. Pleasle consult withpyoiurr HomeOwnersOwners Assoc axon and on rules,
viewyyour deed or any rrestrictions which may arict or . 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 recorc�iVg your Notice of Commencement 4
Signature of Owner/ Agent/
STATE OF FLORIDA,/;.
COUNTY OF gyp` c e�
The forgoing instrument was acknowledged before me
this /', day of 1 {� c20/e by
(Name of person acknowledging)
(Signature of Notary Public- State 201orida )
Personally Known OR Produced Identification
Type of Identification Produced
a G/ *� � 'I}� MYCOMMISS40N#EE
Commission No.
EXPIRES: April 4,:
ur9JE0F FIeP Bonded Thru Budget Notary
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA',k
COUNTY OF
The forgoing instrument was acknowledged before me
this day of f -o it 20i �� by
61ePT �rxoxms-
(Name of person acknowledging)
(Signature of Notary P lic- Sta76f Florida )
Personally Known OR Produced Identification
Type of Identification Produced
E �' ya% , / ��`' c MY COMMISSION # EE 8592
mmission No. �T * ) EXPIRES, April 4, 2017
a� Bended Thru Budget Notary SeNi
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SUPERVISOR PLANS VEGETATION SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW