HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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_ Building Permit Application OCT 2-1 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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Address: 1903� _
Legal Description:
Property Tax ID#: I `tQ2 GGA — oo s> ')— Lot No.
Site Plan Name: Block No.
Project.Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be pertormed under this permit-check.all that appy:
Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors `
.Electric Plumbing _Sprinklers _Generator _Roof
Total Sq-. Ft of Construction:. Sq. Ft. of First Floor:
Cost of Construction: $ e-00Utilities: —Sewer —Septic Building Height:
� N`E%�ES„ -`'E�: ��a C®NTRACT®R• �� ,
Name r wh .moi ..r . Name: G✓ e-G
Address:^TG .z S C-'as0,4 Company:
City: State:2�1 Address: 'S-61 (A i , t'L5 l-c;
Zip Code: f-'L- Fax: City: el-f � Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License C/
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S PaPLEIVIENI'AL�C®NSTRC,TI®N �IENiUU IIFORh/IATIO
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
commenci P9work or recor&g your Notice of Commencement. J
Sig ture of Owner/Lessee/Contractor as Agent for _ ' nature of Contractor/License Holder °y=_
STATE OF FLO STATE OF FLORIDA
COUNTY OF COUNTY OF
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The fo{{ oing instr rent was acknowledg jd before gjg The forgoing instru nt was acknowledged befor ffn S'
thisDl day of 201(0 by �-i this�day of 2V by e'
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(Name of person acknowledging) (Name of persorf acknowledging) �N
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—(Signature Notary Public-State of Flori ) (Signature of Nota Public-State of Florida
Personally Known o-"— OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced i
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 712014