HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO: MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � �.� �� Permit Number:
f�
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 T/
PERMIT APPLICATION FOR: �► Ke �D�e � �C�e�S
� Gt-m G -S C rSO n .�l�Gi'1 r� � a�-1
PRMWSQSED IN�PROVE0M"ENT L®CATION:
Address:
Legal Description:—t I> Ln �a-rli
Property Tax ID #: " Lot No. g_
Site Plan Name: Block No.
Project Name:
Setbacks Front A Back: Right Side: Left.Side:
DE AILED DE�SGR�I'PTI�N OF WORaK:
� r
CONSTRUCTION [NNR{MATION:
Additional work to be pertormea under this permit— check all tat 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: $ %5 OD Utilities: _ Sewer _ Septic Building Height:
01NNER/LE�S�SE `:
CONTRAC�TO'R:
Name ZS_0e D i L'
Name: -
Address: a DD &. 3b-wh
Company:
City: State: �
Address:
Zip Code:,3�9y.!7 Fax:
City: State:
Phone No.? 29- ' 9�Q - 3a -a %/��a"ti 77 ��'/S�
Zip Code: Fax:
E -Mail:
Phone No i
Fill in fee simple Title Holder on next page ( if different
E -Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Comm cement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN_FO.RMATI®N;:
DESIGNER/ENGINEER:
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
STATE ORIDA
Name:
Address:
The forgoing instru ' nt as acknowled efore me
day 2 by
Address:
City:
Zip: Phone
State:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
Personally Known OR Produced Identification
City:
City:
t
Produced Z-
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 thepermit 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
rnr„monrina wnrk nr rprnrriina vnur Notirp of Commencement.
)narture
of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDAS�LUG`2J
STATE ORIDA
COUNTY OF
COUNTOY OF
The forgoing instru ' nt as acknowled efore me
day 2 by
The forgoing instrument was acknowledged before me
this day of 20_ by
this Q_�, of
4P 1
( ame of person acknowledging)
(Name of person acknowledging )
o ry Public- State of Florida
(Signature of Not,
ASignature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identificati
Type of Identification
t
Produced Z-
Produced
.�,�PaJP�' ANG
Commission No. ,�o a�•.. ��@�1)HUFF
Commission No. (Seal)
tary Public -State of Florida
a 10 # v Commission # FF2347 nF'
REVIEWS
a<FOF 5""'
m. xpires
y�iVation
ay 27, 2019 5
R�UPt%150R
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW �
R-'1=17fE1
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
_F
COMPLETED
Rev. 7/2014