HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (?���
Date: / Permit Number: 1/�'
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_e 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:
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Address:
Legal Description:
Property Tax ID#: JL. 2-N 313 - 060 - bob - Lot No.
Site Plan Name: n j Block No.
Project Name: tgr='P a£ 'S��i� GI��y U��
Setbacks Front Back: Right Side: Left Side:
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Additional work to be peffo-r-m--e-d under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
.eqlectric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
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Cost of Construction:$ 7C�c). Utilities: —Sewer _Septic Building Height:
01lI/ ER/LESSEEul" - CONTRACT'®R.
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Addr_.ess �� , - =.-Company:. �`d're.,.S C-.JriCfsC'C
Cit r^� ,__ ::�. �C�C : :C?�(1 State 1
"Address:''-/ S 2-2:".r.. Gc Ajy
Y: -r�T-t-c � ..
Zip Code: _ Fax: City: Stater
Phone No. ��D� -J GCO Zip Code: `329(o 6 Fax:
E-Mail: Phone No (:31Z) 32I - S6 237
Fill in fee simple Title Holder on next page( if different E-Mail Cc,rec iS f ec��rc i(C =,ati�
from the Owner listed above) State or County License C�� 'l 3c;-Jc i C G
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S 1PPI.Ei1/fENTAL C®NS�TR0ET'I®N LIEN i�Ul/ IN{FORM/�►1"I'O`N:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:4 _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-r`esidential 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 our Notice of Commencement.
Signature Owner/Lessee/Contractor as Agent for Owner Signature o ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -0 COUNTY OF
The forgoing instrume?�nt was acknowledged before me The forgoing instru�ent was acknowled ed before me
this.-&7, day of wscsa 20� by this a day of AV O J 201S by
(Name of person acknowledging) (Name of persofi acknowledging)
(Signature of Notary Public- tate of Florida) (Signature of Notary Pu ic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Lt�oys Produced23 L flL, D MAR�E� S
Commission No. �5 � M ommission No. q MYCOMM►�� 6
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REVIEWS FRONT ING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4