HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: :;% Permit Number: 10 -C&O 7
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saw—! 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 —X__ "Residebtial
PERMIT APPLICATION FOR:
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Legal Description: CA, (e- 0,* 1 ) K -C Jo
Property Tax ID#: - 16 SD t ' 1 " 000 i f Lot No.
Site Plan Name: Block No.
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Project Name:
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c1clitional work to be performed under this,permit—check all that appy:
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Mechanical Gas Tank ^Gas Piping Shutters Windows/Doors
Electric _Plumbing Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction: $ Utilities: T Sewer Septic Building Height:
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Name a"v w Name: �: �" 9
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Address: f Company: i 4' y
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City: - -k-eaJ�m or Stater Address: 1e. �✓
Zip Code: Fax: _ City: Ve,z> State: l
Phone No. )7 — Zi Code: -c ?t
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E-Mail: Phone No I 7 '- �'/ 5f IF
Fill in fee simple Title Halder on next page(if different E-Mail z
from the Owner listed above) State or County License C 000,1139
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If value of construction is 2500 or more,a RECORDED Notice of Commencement lis required.
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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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or an9covenants 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 recording your 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 COUNTY OF
The for
, oing instrument was acknowledged before me The forgoing instment was acknowledged before me
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this I day of 20JU by this AV_day of 66Z 20 t(,,, by
o I ILL Q-
(Name of person acknowledging) (Name of person acknowledging)
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(Sig-nature of No-tallotary4lubk-State of Florida) (Signature of Notary Public-Staof Florida
Personally Known OR Produced Identification V Personally Known_OR Produced Identification'
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission "y '-.A.RHAHNA ING
Notary Public-state of Florida
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y P"'�"" LASHAHNA MtG�RAM h A" MgL Fyporp-nec.90 9019 1
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Notary Publi( -Strafe of Florida.. C)mmission#FF IM 19
REVIEWS FIR 11 IWM.1X1i9PJPq*8dft( PLANS Nondi d5fo%TU AiTiEotar) A NGROVE
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C ERXIMrri'ss'(n X REVIEW
a Pd hr,1 110h Natir ,If,
DATE
RECEIVED
DATE
COMPLETED
Te–v—. 7/2014