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ALL APPLI L I S OMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Permit Number:[ VZ9
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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
'P'RO"POSED IJVCPRO.V.EIVIEN,T LQCATLQ;N
Address:
Legal Description:
Property Tax ID#: - UV - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILE'p DES`CYRIPTION OF WO-RK
CQNST.RUCTlbN IN'FOR,MATIQN ."
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Additionalwor to a er orme under this permit-c ec a appy:
❑HVAC Gas Tank ❑Gas Piping, _Shutters ❑Windows/Doors
Electric ❑Plumbing []Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ ��� Utilities: Sewer❑Septic Building Height:
0NER/.LESSEE ''CONTRACT
1NOR y ;:
Name \()hoc wr Name:
Address: Company:
City: State:F-717 Addres
Zip Code: 2 Fax: City: Stater
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Phone No. Zip`-CL�� . 1� Zip Code3�I"LgZ`' Fax: ��
E-Mail: Phone No. �t 7'
Fill in fee simple Title Holder on next page(if different E-Mail: 1 a -C)DYT 1
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLENIENTAL"CONSTRUCTI"ON 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: I
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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 covenants1that 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
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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 Viand posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lend,erlor an attorney before
commencing work or recording our Notice of Commencement.
Sig t of Owner/Lessee/Contractor as Agent for Owner Signa of Contractor/,license Holder
STATE OF FLO D l T STATE OF LORIDA
COUNTY OF L,L�C���J COUNTY OF
The fo oing instr ent wa acknowled a fore me The for in instr nt was ac l nowledg re me
this day of 20 y this day of 20� i
I
P �
�Personally
o aking statement a of perso ` aking statement
OR Produced Identificationersonally Known 'OR Produced Identification
enti ication
Produced Produced
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(Signature of Ntary Public-State of Florida) (Signature of Not Public-State of Florida11 )
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17