HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division coh':�C)2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description: _
Property Tax ID #: i q4 4 ' (f,) D,�2 - oc 'w9 " �� — c) Lot No.
Site Plan Name: Block No.
Project Name: `Q)'>°(
Setbacks Front Back: Right Side: Left Side:
if, SLLILi� r2v IG.7'F' v T TG,JJ r �Q S�eY
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Additional
RUC"ON. INFORMATION:
work to Be pertormed tnatiililios permit- c ec all tat appy:
✓ Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: n% C0 Sq. Ft. of First Floor:
r
Cost of Construction: $ faC)O , CDn Utilities: —Sewer _Septic Building Height:
Name- (41 C L' t O _ Int'
Address: 4 q4 �41 A
City: V% efc e State: EL
Zip Code: 34'9 4 Fax:
Phone No. 4%-1 -,2 4 810
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: i .rGi C C t-,'+rl Ek
Company: _
Address: 15-1 L NAIL) I rk° ' 10 #
cityRC+ St- (,q,CA State:EL-
Zip Code: 4� _ Fakl1-;?
Phone Noi .-23!
E -Mail: Se"ie-e
State or County License: iTczr- , t— i
' l
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
H
SUPPLEM
DESIGNER/
Name:
Address:
City:
Zip:
GINEER:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
WT
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
_Not Applicable
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 recording voyf Notice of Commencement.
Signature4fOwner/ Agent/ Lessee Signature of Coor/License Holder
STATE OF FLORID
COUNTY OF c°, - / _a
The fnent was acknowledged before me
this bLt' day of � 20JLC, by
(Name of perso t�a cknowledging )
(Signature of Notary Public- State of Florida
/)
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No.
REVIEWS I FRO T'
COU
DATE
RECEIVED
DATE
COMPLETED
Rev. 712014
STATE OF FLORIDA
COUNTY OF 5 -t --
The %g
fooing instrument was acknowledged before me
this L day of Al �c?C� :ka c_ , 20ALp by
(Name of pers njcknowledging )
(Signature of Notary7OR
State of Florida
Personally Known Produced Identification
Type of Identification Produced
(!WRAH RUSSELL 1 Commission No.
Notary Public -State of Florida i
1'�t Y it uU
Nov 30, 201
PLANS
REVIEW
_ DEBORIrIfS@glifELL
Notary Public - State of Florida
Commission N FF 179630
Ay Comm ExpireMe
s No 30, c
VE
REVIEW REVIEW
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