HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Dat : Permit Number:
Building Permit Application
Plat ning and Development Services
Building and Code Regulation Division
23017 Virginia Avenue, Fort Pierce FL 34982
Ph ne: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PER APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: .,►Q 1QQb7le -
Legal Description: zJ0,1 kl�� S
Prop rty Tax ID#: o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit-check all apply:
HVAC Gas Tank Gas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers E]Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: of First Floor:
Cost of Construction: $ L) 0 Utilities,-.In—Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name ,e,& /1')a./1yy Name: _ -12 � /�t-
Add ess: 615r7 �/i Za�ay 6e- " Company: c h cer3�)Yif --
City: '_ 1'1 C"`C C State:FL Address:735 1J r-;ve sta-8 __
Zip ode: *3 q(i'J/ Fax: City: sc aL-4/ >Ln State:_E�--
Pho a No. i7J 81�/ - -39 17 Zip Code: 3c29,54? Fax: Z7,2- 91ef-
E-Mail: Phone No. 17-9-9/8-117e9?
Fill in fee simple Title Holder on next page[ if different E-Mail: hnr�.c: ` .�lcc�tGtl. iD1a.C'tn'1
from the Owner listed above) State or County License: /?Jqo- 1 SsV Yd A 7
L
a of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU PLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DE IGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Na e: Name:
Address: Address:
City: State: City: State:
Zip Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Na e: 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 ceri ify 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 for any restrictions which may apply.
In co isideration of the granting of this requested permit, I do hereby agree that I will,in all respects,perform the work
in ac ordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The f Ilowing building permit applications are exempt from undergoing a full concurrency review:room additions,
acce sory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WAI INING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
imp ovements 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
corr mencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor Licens of er
ST TE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of h 2oj'7 by
e—(\J)
Name of person making statement Name of pars making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(S gnature of Notary Public-State of Florida) (Signatur ot.,Nv,cY PgWXRktFl$ TI 69t!tkAN
MY COMMISSION#FF�038'a �9
Commission No. (Seal) Commissi ri bruary25.�SM
i,�OTi�9;1,C'rr3 Nondalloiey$evirecarr
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
R ECEIVED
DATE
COMPLETED
Rev, 8/2/17