HomeMy WebLinkAboutBuilding Permit Application (2) Ii
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S!IJiPPLI'M�ENTA CO'NSTR' CTlO.N I .; AW IN'FORMA�f!'(J:�' ,
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY; _Not Applicable
Name: Name: II
Address: Address: i l
City: State: City: LI 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.
certify that no work or installation has commenced prior to the issuance of a permit. I
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 andp'covenan'ts 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,i,n 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 tolanother non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to ur property. A Notice of Commencement must be re orded�and posted on the jobsite
before the firs ns ection. If you intend to obtain financing, consult w' i ender or an attorney before
commencin wor or recording your Notice of Commencement.
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Signatu Own r/Lessee/Contractor as Agent for Owner Signature of Co ractor/License Holder
STATE OF FL RIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
.f
I�
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 ack wledging) (Name of person acknowl M yging)
I.
�)ublir-'-0;te
(Signature of Notary Public-S to of Florida) (Signature of of Florida)
Personally Known OR Produced Identification Personally Known iOR Produced Identification
Type of Identification Type of Identification
Produced Produced ,.
C, \a 004.S3. 0�ko '0
Commission No. (Seal) Commission No. i (Seal)
a"2 Notary P bli RANI ° "� Notar HN INGRA
REVIEWS FR0N, ?;' 11141Cromm ES 50Rd PLANS VEGET j {` y� p t l�( RO E
COUN ER' ;� •I UBommi si � .201 EVIEW REVIH�W% Q;�S;°� R�� sxPire pe�
DATEnn
National Notary a througp Natio 7249
Y Assn al Notary Assn,
RECEIVED
DATE
COMPLETED
ev. /2014
I
All 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
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRS OSiED INP_ OUEMENT LDCA ION:
Address:
Legal Description:
Property Tax ID#: 1 'V� ' �a ��C.d`� Lot No.
Site Plan Name: Block No.
Project Name: t'a�
Setbacks Front Back: Right Side: Left Side:
DET I,L:gip
RES'�
C�O�NS�TR�UCTI� FN�FO I�/l'A�TION.
Additional work Ube pertormed unde t is permit-check all tat appy:
: /eanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
lectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 02 7,---- Utilities: —Sewer _Septic Building Height:
Name Name: o/ 2 ��Ple 1
Address: ,fZ�e- iic Company: 12� G
City: /�%G e- State: F Address: fs
Zip Code:3z{llo�,/ Fax: city: 9 G State:
Phone Ngl 77� -35-?-'-O?o� y� Zip Code: Fax:
Fax: 77��<5�✓?����
E-Mail: J1Ryc:r-0 G 0'PL Phone No 77 —"5'X
Fill in fee simple Title Holder on next page(if different E-Mail RA/
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.