HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
MINOR bil
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
PROPOSED IMPROVEMENT LOCATION:
Address: Sl CJ ), U)un' l
Legal Description: �, tA-c. c,, `� `� p a -3f go
L-ol Ic�S a .4G C.G� McP 341aS ' )�o� �c1 - 10.d��
Property Tax ID#: 3UO3 ' Sack • �31C1—I - aCSO — Lot No. InS
Site Plan Name: c Block No.
Project Name: .0 k.—k \N-A
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
iti a wor to e eorme under t —checkispermit a aMK py:
p
#IVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
OElectric 0 Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$_ 1 t-�i� I , S3 Utilities:llSewer OSeptic Building Height:
OWNER LESSEE: CONTRACTOR:
Name �ChY�6¢,\ �\ lVz'(r Name: t.. —
Address: S\ a dlf\ �� Company:�7t�°-k&o Gs S r t( kl�n—�
City: . �e CCsz_ State-G Address: SL{Ln��1 �r\c sz �6`�.. 4 k
Zip Code: �L�`T) Fax: city:l'�6,t =,, State:2-
Phone No. S� " ?��; _ � Zip Code:3 33 14 Fax: 9i SL4-3IT -C7S 4
E-Mail: Phone No. CIS\-i-4 - S 1 . —111 Q
Fill in fee simple Title Holder on next page (if different E-Mail: 12r tY�- A*• e ,V<7, C= n�
from the Owner listed above) State or County License: - g1LAa
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 TITLEHOLDER: ,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 andpcovenants that may restrict or prohibit such
structure.Please consult with your Homeowners 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 1 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 first inspection. If you intend to obtain financing, consult with lender or an attorney before
commenckmwerVor recording our Notice of Commencement.
Ig a e of Owner/Lessee/Contractor a &ent r OwnerrTATE
ontractor/License Holder
STATE OF FLOW�1pA OF FLORIDA
COUNTYOF COUNTYOF %.:3C-r
The forgoing instrument was acknowledged before me The forgoing InstruuLment was ecknowledged before me
this�day of V,,r �20 r7 by this�day of-`_V_QkpN 20� by
1 1 c Can a�a �:nc-c)N2— t-Cv-c� fNQ—
Name of personm kin tatement Name of person malking stkement
Personally Known �Z, OR Produced Identification Personally Known OR Produced Identjfieai lor-
REVIEWS Type of Identifica Type of Identificatio — STAProduced " °� $TAr t - rAGURA Produced sloNMYCOAA AVSnION#FRWd 1316o; EXEXi1[1 !,FcbrUaty� 2f118(Signature of Notary u ic- tate of Florida) (Signature of Notary Puis ate of FloridaCommissionNo-�c0535
gCo (Seal) Commission No.��rJtCe'3S(o (Seal)
FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17