HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �1 Permit Number:
J_
i RECEIVED AUG 16 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 _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line v qL
PROPOSED IMPROVEMENT LOCATIIIN -
Address:
Legal Description:
Property Tax ID#: 17 Lot No. _
Site Plan Name:-0 , G , E>C Block No..
Project Name: e2 M 1
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CL 1/-."o tte -
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit—check all appy:
HVAC Gas Tank E]Gas Piping _Shutters ❑Windows/Doors
0 Electric 0 Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 7 ' Utilities: Sewer Septic Building Height:
OWN R/LESSEE: , CONTR TOR:
Name 1 Name: l dl
Address _ Company:
City: State: Address: J
Zip Code: Fax City: State.
Phone No. 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 commencement is required.
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:
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 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 pr erty.A Notice of Commencement must be recorded and posted on the jobsite
before the first insp Ion. you intend to obtain financing,consult with" before
commencin wo or reco din our Notice of Commencement.
r ���114o
Signature f Owner/ se ntractor as Agent for Owner Signature o Contractor/L ce older
STATE F FLORIDA STATE O FLORIDA ,
COLIN OF' 6)r. L11a•�'C COUNTY OF b
The for oing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this %49 day of 20A I by this day of d ,20� by
vf'�a -r, ,n C a,S�'n {'
Name of person making statement Name of person making statement
Personally Known OR Produced Identification F--.1f)iL, Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced r. 'b V Produced L-
(Signature of Not DEA IEGNEAIs (Signature of No r�i:' .StateWfIldeMlj GIVENS
V.
v g'�••,,• GG 022023 MY COMMISSION#GG 022023
MY COMMI SION# 2020 PIRES:De 2020
Commission No. o �er16, Commission No. �a `T1`a '
EXPIRES: F F� n d Thru Notary u Ic ndenw tens
� o= publIGUn ��
de
;, t
`sv . Bo,d-d_VhrL1N0tari
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17