HomeMy WebLinkAboutpermit application formALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f I S I I Permit Number:
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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 Y—
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: —7lo cl 1
Legal Description:C 2 < p C\� c� �rw���C �C J }��` (_� a z�
Property Tax ID #: Lot NoQ3
Site Plan Name: Block No.
Project Name: 0lhal f-,(, 4y1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: _
Aaamonalworl<tobenertormed under tispermit—check all appy:
HVAC GasTank Das Piping _Shutters Windows/Doors
U Electric Plumbing ❑ Sprinklers U Generator F.] Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ c l6i LcQ • a `"i UtilitiestSewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR: Willi
Name
Name: r eCVnr,-R5 n0—
Address: --1 (o G
Company:S�L
City: �OC� 5-E . I .)C�i Stater
Address: `xFloO 1,J • c o VA %. A to
Zip Code: ::� 4q T to Fax:
City: Stater
Phone No.--7-7 Q •
Zip Code: 333\L-� Fax,-GS4-:31% - 05$�
E-Mail:
Phone No. C s�-1- S:zc1 \ k 0
Fill in fee simple Title Holder on next page ( if different
E-Mail: .\-Ns cox ct—, oc�n a C„ C;or'1-^
State or County License: C'GC. - n-:-,Tl 4a
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: ift
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
UWNLK/ CUNTRACTOR 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 an -d posted on the jobsite
before the first insp ion. If you intend to obtain financing, consult with o n attorney before
commencin recording vour Notice of Commencement. T7
Owner/ Lessee/Contractor asRFfor Owner 0 ontractor/License Holder
TATE OF FLORIDA—, SfATCOF FLORIDA
COUNTY OF _F,yn COUNTYOF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ItA day of GacL�c� 20j� by this L day of GJ�n�ec� 20 1 by
—6 j
�(1 c C VNG
Name of person makinistatenlilint Name of person making st tement;
Personally Known _D�_ OR Pr ced IdentifWatlo4..-.,�,� -, -PersonA4 Known _Z4, OR eatd"rcati0n - 8 —:=
Type of Identification rt • FTypegfl ntification'�rFti�
$ i'
EXFfRES F_bruary
(Signature of Notary Public- StAe of Florida ) (Signature of Notary Ptubl, State of Florida )
Commission No. a s l (Seal) Commission No. a I (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
Rev. 8/2/17