HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICAB{ E INFO YUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I� Permit Number:
MI I
ua
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
pa, nP ROVEMEN LC A" ,t:o ,
Address:
Legal Description:
OD Com -c_' -
Property Tax ID #: Lot No.
Site Plan Name: _ _ Block No_
Project Name:
Setbacks Front Back: Right Side: Left Side:
i
5p411 n -c-
cr') i ✓v,c�Z c' Yaa_LJ mzbf c- ] c— -
❑ HVAC
Electric
❑ Gas Tank
❑ Plumbing
Total Sq. Ft of Construction,
Cost of Construction: $- �-
❑Gas Piping
,❑Sprinklers
L_J Shutters
❑ Generator
SFt. of First FFl`o'jor, _
Lltlities:Sewer I _JSeptic
❑ windows/D=5
0 Roof Roof pitch
Building Height:
ODUIERfSSE:
CONTRACTOR:
,.
Name i r Y' t' f-
Name: /71,
Address: �(� .fQ
Company:
City. �c� ' ST" u r:rF Stater
Address: C} t
Zip Code: `z` `j - Fax:
City: 2 Ale'r- State:
Phone No. `7 7 '2--
Zip Code: 3 7 S� 2- Fax:
Phone No. 72-:z-16- O ll ' 6
E -Mail:
Fill in fee simple Title Holder on next page ( if different
E -Mail: ,, Ir, 5't7
from the Owner listed above)
State or County License:�
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Not Applicable
Name -
Address:
City State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
game;
idr
fir:
Zip: i Phone:.
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:
Address:
QtVa
71p: 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 representafion that is granting a permit will authorize the pemit holier to build the subject structure
which is in conflict with any applicable Home Owners rules* bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Horne 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 pians, 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 fates 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 pasted 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,
Rev. 8/2/17
Signature of Owner/ Lessee as en er
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF 1c�h�
STATE OF FLORIDA r
�cc,'
.
COUNTY OF
The f .ng instrume was acknowledged before me
The forgping instrume t was acknowledged before me
this day of ,S V 261) by
tHS Q -day of u3)— " 2Il a by
Name of perso making statement
;:�;.l `�-,
Name of person making statement
; y+Ss;,`
Personally Known ff OR Produced Iden
Personally Knownti� OR Produced Identification
Type of Identification
Type of Identification
Producced'•°t
�`
!•llIP1111\1+�
Produced
"8` • '`
l!l IRIf \.•\
(Signatu a of Notary Public- State of Florida j
^.
(Signature of Nota Public- State of Florida)
'"• x Q
0ha
tib'
Commission No_g i,aL (Se
T
Commission No. [�� t✓ �i (Seal)
m
@
ft
aQ m
CR Cn T
�¢o
O ¢^
!n G A
REVIEWS
FRONT
ZONING
ISOR
PLANS
VEGETATION
SEA TURTLE
M
COUNTER
REVIEW
REVIE
REVIEW
REVIEW
REVIEW
REVIEW
PATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
$
'�
S
M