HomeMy WebLinkAboutBUILDING PERMIT APPLICATION?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
)ERMIT APPLICATION FOR:
Building Permit Application
Commercial Residential ________
%ddress:
Legal Description:
_ Lot No..
Property Tax ID #: L�o % �a ` Block No.
Site Plan Name:
Project Name:
Back: Right Side: Left Side:
Setbacks Front
Z -T-,, A /� C le -7 f ('p r� (- ,7
Mechanical
Gas Tank
Gas Piping
Shutters
Electric Plumbing _ Sprinklers _ Generator
_
Total Sq. Ft of Construction:
Sq. Ft. of First Floor: —
Cost of Construction: $ > Utilities: — Sewer _ Septic
Name -V aTta aC& 44
Address: C t
City: titi n
State: �' 1
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: (',urtl5 S w on S
Company: C�As�E„1� ACc ��1Sfeln� )AIC
Dt-
Address: � S o
�-State:-LL
City: Vo T ST 'iu cC 't -
Zip Code: 3 &?j Fax: Ila J 35 ) U S
Phone No. i _7 ^ 3 �-3 2
E -Mail:
State or County License: CA C 0 5 )S !O S�a�
ired.
If value of construction is^2.5Kor more, a RECORDED Notice of Commencement is requ
e
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City:
Zip:
one:
Not Applicable
State:
— Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City:
Zip:
Phone:
State:
BONDING COMPANY: Not Applicable
Name:
Address:
r �+,,
_.-,.
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 thepermit holder to build the subject structure
which is iconflict 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.
n
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 our Notice of Commencement. ^
Signature of Owner/ Agent/
STATE OF FLORIDA
COUNTY OF 371 6Z- Zee
The forgoing instrument was acknowledged before me
this day of Chi 20 1b by
(Name of person acknowledging )
(Signature of Notary Public- State of Flor' )
Personally Known OR Produced Identification
Type of Identification Produced "Alf puo
io .•... CHRISTINE B.NENGL592
Commission No. eI�Y
COMMISSVONNEE892
EXPIRES: April 4, 2017
Bonded Thru Budpet Notary Servi
Signature of Contractor[License Holder
STATE OF FLORIDA L7
COUNTY OF�� a(�IGGc-Z
The forgoing instrument was acknowledged before me
this Lx" day of L -L 20 by
K?%il%l�� �S -
(Name of person acknowledging)
-- / 2�
(Signature of Notary Public- State of Flo; a )
Personally Known �OR Produced Identification
Type of Identification Produced
pGHRiSTINE B. ENGU
Commission No. LSE syolU aw My COMMISSION 9 EE 85!
EXPIRES: April 4, 201
Rrnded Thru Budpot Notary Ser
PLANS
REVIEWS FRONT I COUNTER I REVIIEW I SUPERVISORNG REVIEWREVIEW
DATE
RECEIVED
DATE
COMPLETED
VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW