HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: (�� 0�I U
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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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: 'I I .
Address: �S2-0
Legal Description: `lam
,r4aP 0.335 Viz; 3`- l 4'10
Property Tax ID#: c 7 4-7 / Lot No. 31
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I'
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CONSTRUCTION INFORMATION:
Additional work to beop
r orme under this permit—check a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers E]Generator E] Rooif Roof pitch
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Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ Z��� Utilities: _Sewer[]Septic Building Height:
OWNER/LESSEE: .CONTRACTOR'!
Name '_Tc_r�__ Name:
Address: Company: o 4.....
City: State:_ Address: 30Z'1/,1ViJ
Zip Code: Fax: City: State-
,Phone No. Zip Code: Fax: 77Z_Z9/ -71,7171,
E-Mail: Phone No. [
Fill in fee simple Title Holder on next page(if different E-Mail: - -/��%qg'4
from the Owner listed above) State or County License: (3
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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�"SEJPPt�M NAL C(7NST UCTIO xI,EN LAWsI t i3 RIVI�1TTO:,
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QESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
-" - --City: -- ------ -- --"- -- -- -----State: -City:
Zip: Phone Zip: —!Phone-',--
FEE
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 workiand 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 forany 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 accessoryuses 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Si ature f ractor/I icense Holder
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STATE OF FLORIDA STATE OF FLORID
j COUNTY OF COUNTY OF ,cc �EllGlt"
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by. this, day of R9,&C cy ; ,20/ by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification .r
Type of Identification Type of Identification
Produced Produced
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d 1g,7 Oft yasaile7
(Signature of Notary Public-State of Florida) igna of ate of ddb�FIOf�da
Commission No. (Seal) Commission N
T1f1 ssiorxkpit6S 03/19/2018
n '11H4919n NO,FF 103713
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION ;' SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17