HomeMy WebLinkAboutBuilding Permit Application 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 recording our Notice of Commencement.
Signature of Owner/Lessee/Contactor, Agent for 0 Signature of Cgn ctor/License Holder ;i�:'*;�pf;]
STATE OF FLO ID TATE OF FLORI A
A.
COUNTY OF a m� UNTY OF
The forgoing ins ument was acknowl before me � v,— he forgoing ins ent was acknowledeee m 20 0thiC: •0 day of C�C by ' isday PC ,2 W
(Name of person acknowledging) ame of person acknowledging)
Lai
(Signature ofj4otary Public-State of Vlorida) (Signature of Notyy Public-State of Florida)
Persona(lylEnown OR Produced Identification Personally Known OR Produced Identification
Type of Identi i a ' n Type'of Identif ati n
•
Produced r Produced -
Commission o. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW . REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE ►
COMPLETED
Rev.
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1(01a 00,
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
;I
PER APPLICATION FOR:
i
PROP®SED 1N°:PROufMEN1' LOCATI��ON:
Address: Vim•
Legal Description:
Property Tax ID#: u0lldt ' llJ® Lot No.
Site Plan Name: Block No.
Project Name: ,1
Setbacks Front Back: Right Side: Left Side:
�i
C-c-o .-0h -ems
CONSTRUCTION,�INFORMATI:ON;
Additional work to b e performed 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: )JI) rl�) Sq. Ft.of First Floor:
Cost of Construction: $ o�D D Utilities: _Sewer _Septic Building Height: I
i
O��N'ER/L"E�-SES. , C�OT�ACTO;R:
Name `o e Name:__!"'V__
Address: Wtk*NkIz v.
City: ? S State: `, Address: 'Lr,3"1 S
Zip Code: S`( Fax: City:
Phone No.�— �' p— 31S 3 Zip Code: 3 `�� Fax:
; I
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 'J
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
w
KPPL-1MRNSMA2 C®I�STRUCTIO!N LIEN LAW I°NF�R°MATI®:N:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Zb6 Address:
City:,_7;=�t 1 State:_ City: State:
Zip: 3!j-9 meq_Phone 9`�1� ,Itn-1384 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 recording our 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 forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this day of ,20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature.of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced -
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE „ MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW' REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014