HomeMy WebLinkAboutBUILDING PERMIT APPLICATION 1-20-17 -All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Z-0Permit Number:
,C
s
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 6
;MPERMITAPPLICATION FOR: - � � � Lz OzrS 5d(
,J
-Address: S'46 pw/h �n-
Legal Description:
;,Property Tax ID 09 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back. Right Side: Left Side:
Who-W_
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _ShuttersWindows/Doors
_Electric _Plumbing _Sprinklers _Generator 'Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
most of Construction:$ '1v0-O Utilities: _Sewer �eptic Building Height:
NameIltA Name:
Address: ! a Company:
City: (24- 2;ory- State.& Address:
Zip Code: Fax: City: State:
Phone No. (7 711 Rb I - :7 f$a Zip Code: Fax:
E-Mail: ���a1Q , feo�yCA ��a`i�y . pr's- Phone No.
Fill in fee simple Title Holder 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 Commencement is required.
,WN,
DESIGNER/ENGINEER: Not ApplicableMORTGAGE 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 rrtade 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/Agent/Lessee// Signature of Contractor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF L. COUNTY OF
The ng instru nt was acknowledg d\4fore me The forgoing instrument was acknowledged before me
this ay of 20 y this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notiry Public-State of Florida) (Signature of Notary Public-State of Florida)
Personall K .- OR Prod d Iden ' a ion Personally Known OR Produced Identification
Y
Type of Ide igaitioType of Identification Produced
'=�*Pa P���n. A M HUFF
`�* Notary public-Stats Commission No. (Seal)
Commissio, d`. _ mal r►da
•oQ ion#FF 234730
,F FLOP�.` My Comm.Expires may h � � Y 27.20
aionalNotary A s9- PERVISOR
REVIEWS FRONT ZON N PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW, REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.