HomeMy WebLinkAboutBuilding Permit Application,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: ,2 7
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit Number:
Building Permit Application
Commercial Residential
Address: �c%� a,i2� `&
Legal Description:
Property Tax ID #: %L� V /�4 Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
1 <
it-iQnal work to be performed under this permit –check a
Mechanical _ Gas Tank _ Gas Piping
PPP
Shutters _ Windows/Doors
_ Electric _ Plumbing — Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: —
Cost of Construction: $ Utilities: _ Sewer — Septic
Name
Address: 1,nf5C 5�
City: Ila/1 . n , e - State: F�–
Zip Code: Fax:
Phone No. �7�J 7505F
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Roof
Building Height:
Name: ('_uc%t5 .Sa.mrnon S
Company:
LA L
S� S fe m.s �tii L
Address:
S �- �i I
(' Dr
City: Vice -c ST Luce
_State: FL.
Zip Code:
34�Sl
Fax:
Phone No.
772 33,5
E -Mail:
C'c
State or County
License:
CAC 05 IR /O
If value of construction is?.S9dor more, a RECORDED Notice of Commencement is required.
7�10D
Name:
Address
City: _
Zip: _
Phone:
Not Applicable
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City -
Zip: Phone:
—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
swhich is in tructure. Please with
any
lome Owners Associrs at on and reviewon
your deed forcovenants e restrictions which wh ch ay atrict 6r . prohibit such
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
.�I, ,..^. A;.nn %iniir Alntirn of rnnnnnpnrprr cant.
cUrrlrrlel cin woI ic'.vIT vu. ..��........ .........._..__..._----
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF .
The for oing instrum nt was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20.E by
this _01 day of 120LZ by
r mors/✓
(Name of person acknowledging)
(Name of person acknowledging)
4
(Signature of Notary Publi - tate o orida )
(Signature of Notary Public- State of orida)
/
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
e •.
Type of Identification Produced
°.: "•• ' 1 HNSTINE B. ENGLISh
CC�#*MY COMM4missionNo.L���yo�0�
* g �COMMISSION0EE859284
Commission No. EXPIR�rApril
4, 2017
ii:tnded T11N8od�
Thu Budget Notary Seroce�
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVNS
REVIEIEW
kNp
VEGETATION
REVIEW
SFA TU RTI FMANGROVE
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014