HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION°TO BE ACCEPTED
Date: Permit Number:
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 ✓ Residential
PERMIT APPLICATION FOR:
Address: `3)l b bt-
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
L 1,e. L,% v e.
Mechanical Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ (Ok ,
• �.o Y
Lot No.
Block No.
Pei rniL—ulr40nan uwLOpply.
_ Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
_ Windows/Doors
Roof
Building Height:
Address:, , CC0_b6A:2kvkP . .DfL Company: C�A!5-rgm Vr Su s e � )ki c.
City:r1C' k- State: Address: 1, � 1 S Dr,
Zip Code: a Fax: City: VoQT ST L4Cte= V� State: FL.
Phone No. rATA2. - ZOL- _kn Zip Code: 34T&I Fax: ' 7,; 33S 1 t F
E -Mail: Phone No. 772 33,5 -331
Fill in fee simple Title Holder on next page ( if different E -Mail: cu sta Ir c V oo) •(.C -M
from the Owner listed above) State or County License: CAC 05 I? !O ' S-lCLte_
If value of construction is2.%C'or more, a RECORDED Notice of Commencement is required.
7,� -0 0
It
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 recor ' g your Notice of Commencement. -
Signature of Owner/Agent/lessee Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of A(// 20 by
(Name of person acknowledging )
STATE OF FLORIDA �,�
COUNTY OF �G
The forgoing instrument was acknowledged before me
this day of J)(i.7-20 /� by
(Name of person acknowledging )
(Signature of Notary Public- State of FI a) (Signature of Notary Public- State 0 f11
rida )
Personally Known I' OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced _ Type of Identification Produced J'Ry P,,.'
c' p�/ ?°�; •••.°�% CHRISTINE B. EN&1)t' uynwntvt rs. tlVIiIISFP
Commission No. L �? 7a / w I� MY COMMISSION# EE8512Commission No. t �0 ���U 7* �)MYCO EXPIRES:
2017
EXPIRES: April4.2017 , ° EXPIRES: April4, 2017
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REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //ZU14
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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