HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED
[late: Permit Number:
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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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Andress: T 6 d 2 (cc,c I Ave
Legal Description: Lc:lez4,rocd GILC 13
Property Tax I D#: l 3 D f f 9- - 0 ; c�.— u — Lot No. r
Site Plan Name: Black No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to e e orme under this permit—check a apply:
VAC fn Gas Tank ❑Gas Piping _Shutters E]Windows/Doors
Electric Plumbing Sprinklers 0-Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
WJ
Cost of Construction: $ Utilities: Sewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Namc c&A �I �cCX Name: .� ter. ,-� Jea � -
Address: � '� ���nc� �,/�. Company: ��✓/Id � �C
City: s.4 State: ;�_e_ Address: _�r(ra _ - Pre-55(IL
Zip Code: Fax: n
City: �._��'" �!_<X-- _ � .State:���
Phone No. -7-72- 2 7/` 253, Zip Code: 'W f i:,- Fax: 1wi .
E-Mail: Rhone No. —7-7 - R/6 — e 5
Fill in fee simple Title Helder on next page{ if different E-Mail: Q r✓M�; /l L C� (' z Cu 5�,Ae
from the Owner listed above) State or County Licenser ` c/
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 permit holder to build the subject structure
which is in conflict with any applicable Horne 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 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: roam additions,
accessory structures,swimming pools,fences, walls,signs,screen roorns 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
commencing work or recording our Notice of Commencement.
F
Signature o n Lessee/Coonnt r'as Agent-for owner e of tra ' /License Holder
STA LORIDA STATE OF FLORIDA,,
COUNTY OF . L �.t�•, COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�clay of� e„ 20 i� by this `day of 1C= e- 120 2 by
a of persan.making statement ame of person making statement
Rgsos_o_aa nown__Z OR Produced Identi cl "'� Personally Known i� OR Produced)dentificati' =
Type of Identification p= Type of identification
i= � C_
Produced . Produced °�, y>,
�'rnein�'r
( ' nature of Notary Public State of Florida 1 a .44 Signature of Notary Public-State of Florida ) x
Commission No, f (.Sea s Commission No. F (sea
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REVIEWS FRONT ZONING 531 E ViS R PLANS VEGETATION SEA TURTLE o n O
COUNTER REVIEW REVIEW REVIEW REVIEW I
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17