HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:T� �1 Permit Number: 11 1:121) rz 55
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RECEI�'__D JUN 3 0 2017
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 r/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
VN C-
PROPOSED IMPROVEMENT LOCAT ON:
Address: // 7 &vPP-' � Ml-vV e!"�
Legal Description:
Property Tax ID#: /tl/q 7 0 o 00 Ick 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Adclitional work tobene orme under this permit—check a appy:
HVAC LJ Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers E Generator F] Roof Roof pitch
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of construction:$ 571y Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
I(Name Name:
Address:__j-__ ,4 Company:
City: F /D/LC a State: Address:
Address:
Zip Code: 3q 9(l 7 Fax: City: State:
Phone No. '_2P6 S cP� J' ` Zip Code: Fax:
E-Mail.
f' G' Phone No.
Fill in fee situp a 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 Commencement is required.
J
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _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:
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 wording our Notice of Commencement.
S
Sig re of Owner/Lesse /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5k, L Q COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this3y day of U vrZ 20 ".by this_day of 20 by
44nse�o IvIt%li't 6
(Name acknowledging) (Name of person acknowledging)
(Signature of Notary Publi State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Iden ' ersonally Known OR Produced Identification
Type of Identification Pro ►E GIVENS ype of Identification Produced
COMMISSION#GG U
Commission No. �5 I)ES:DecemberlS.2t)2o mmission No. (Seal)
';+ Q Bonded ThN Notary p
ubllcUndellflt s,
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS