HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '7A Permit Number:
•
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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ERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
OPOSED IMPROVEMENT LOCATION:
Address: Sf Gr\C 6� C C--}-2,Z r�s�
Legal Description: -)h-c'
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
G ( C_ --CxA:A--
4 .7 V_� p�� � I _V
CONSTRUCTION INFORMATION:
Additional worK to e performea un eri ms perm it-checka apply:
VAC1:1 Gas Tank ❑Gas Piping _Shutters Windows/Doors
RHectric
0 Plumbing Sprinklers 1:1U Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ _C1�5 L} Yi I Utilities. Ft
0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Uo 'M %C�Y-'\ Name:
Addr�. 1' CtDtVc--_-c_ (—Grp- Company:
City V(3c csk-- L__,i C�2 State. Address:
Zip Code: 30FAS5 >- Fax: city: Qr'L_X� State:—&
Phone No. 1 1- a C)-7 ---_1_ toy" Zip Code: Fax: 9 S4 IS -C 63
E-Mail: Phone No t0
Fill in fee simple Title Holder on next page(if different E-Mail: r\Cr I�JL)O to aC_
from the Owner listed above) State or County License: C0.L7- CD W 1 L'I
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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants 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 ' t ' pection. If you intend to obtain financing, consult wit nder or an attorney before
comme I k or recording our Notice of Commencement. 1.091,
of Owner/Lessee/Contractor as Agent for Owner a of ontractor/License Holder
ST TE OF FLORIDA \\ TATE O FLORIDA
COUNTY OFxor�a� COUNTYOF ���t ,
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this 3 day of Qp c_ ,nn 20-0 by this 31 day of r 0 cpnr 201 by/
Name of person making atement Name of per on making staVement
Personally Known X_OR Produced Identification Personally Known JL, OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary uric fie o (Signature of Not nPuG Late o �j a
(fmo�t� •s MY COMM SSION#FFOB835K G MY O A�i SI N#FFO&n9�c
Commission Nall' - IR-S F� agry 2,207L
EXPIR(-SB31hbrO �Y 20t COmmISSIOn NO.
(60])3..:913 F!OritlaN�i�: � vim.• M (Si
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17