HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE I FO MLISr 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:
----------------
PRCIPOSED IiN 'RQUEME�NT L®CA ION:
Address:
Legal Description:
Property Tax ID#: �-[ V 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE D �EMMM O O
CANS U Tf0 IN -=MAT .
itiona wor to be performed under this permit-Check all that appy:
_Mechanical _Gas Tank _Gas Piping _.Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First-Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OW LE�StiSEE. C�DNTRACTOR:
Namee Name:
Address: �' 1/u ' S Company:
City: //terc'e State: FG Address:
Zip Code: '7� Fax: City: State:
Phone No. 2 n7_5 )-12_ Zip Code: Fax:
E-Mail. 3 G .1, Phone No
Fill in fee simple Title Hoer on next page(if different E-Mail
from the Owner listed above) State or unty License
If value of construction is 2500 or more,a RECORDED Notice of Com ncement is required.
SUPP EMENTA CONSTRUCTION LIEN LAW INF®RMAT ON:
DESIGNER EN _ 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/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA n STATE OF FLORIDA
COUNTY OF `�' COUNTY OF
The,fgrg-oing instr e a acknowledgAbefore me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20_ by
(N a of person acknowledging) (Name of person acknowledging)
(Signature of Not Public-State of Florida) (Signature of Notary Public-.State of Florida)
Personally Known OR Pro uc d Ide ti 'ca 'o Personally Known OR Produced Identification
Type-of Identification Type of Identification
Produced ,,��°ay p�B ANGELA M HUFF yp
y Public-State of Florida Produced
commission #FF 234730
Commission No. N.' 'o;= My(;dAwaPcpires May 27,2019 Commission No. (Seal)
A FF Bonded through National Notary Assn. .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014