HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �}
Date: Permit Number:31
- Q� -. R E C E I'."S D A J3 X1 2017
gttfl 'ing I erMii Wpiplication
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: To Select from dropbox, click arrow at the end of line
-PROP OS.ED IIVIPROVE MENT.LOCATI'ON:
Address: Rle—
Legal
Description:
Property Tax ID#: Ua35 '3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
®ETAILED DESCRiIPTION°OF°VVORK ;� T�` ,`}°
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Additional work toe nertormed under t is permit-c ec all appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing Sprinklers E Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S"Ll. Ft.of First Floor:
Cost of Construction:$ �w Utilities: Septic Building Height:
OV1/N,ER ,LES,SEE SCO NTRACTO R: ,
Name Name:
Address: Company: -
City: /(!L State:_ Address: C)
Zip Code: Fax: City: State:
Phone No.__1-(7_-SCT -( C) (rJ Zip Code_,_5_H&1Z Fax:
E-Mail: Phone No.
.- 4U I—8'3Z
Fill in fee simple-Title Holder on next page(if different E-Mail: Sn'`'~ I i- C
from the Owner listed above) State or County Licen� .� K
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION`:
. � pp.. MORTGAGE COMPANY: No _. .
DESIGNER ENGINEER: Not Applicable t 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 recording our Notice of Commencement.
s
Signat e f Owner/Lessee/Contracto s Agent for Owner Signature o Contractor License Holder
STATE OF FLOgl[?A STATE OF FLORIDA
COUNTY OF t -1Y. COUNTY OF Y- t-t1 e,\ k
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 day of ayd, 20 1by this `` day of 20 LJ_by
(Name of person acknowledging) (Name of person acknowledging)
L��
(Signature of Notary P lic-State of Florida) (Signature of Nota ublic-State of Florida)
Personally Known OR Produced Identification nally Known OR Pro ced Identification
Type of Identification Produce sy of Identificati
D QYp�'•, DEANNAMARIEGNENS
aYg`,y CSP...•
Commission No. � 1 'r� � Se� CGMMISSION#GG 022 23 MYCOMPdIS�I�� 'JG022023
_ PIRES:December16.20 (Co fission No.
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Bonded Thru Notary Public Unde 'tern o; PIRES:D cem 16,2020
B Bonded Thru Notary Public Underwrites
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS