HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: h0q. 3
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 VY
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
;PROPOSED IMPROVEMENT-LOCATION: .
Address: 3a s etu_- F
Legal Description: Wa S E JLC )VO. ®JV+S' ( P13 o7-J �{
(ol o � 367q-37
Property Tax ID#: 6p6ced lb % 3- 0— 00-75- 000 - 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 nerformed under this permit-check all appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric ElPlumbing Sprinklers 11 Generator El Roof Roof pitch
Total Sq. Ft of Construction: 0 Sq. Ft.of First Floor:
Cost of Construction:$ /000, 0 o Utilities:0 Sewer[]Septic Building Height:
.OWNER/LESSEE: CONTRACTOR:..
Name A 14 Name: o ' I
Address: Company: /)I72/
City: �� , �i�'ci�i State: Address:
Zip Code: `'�° Fax: City: � tl t�� State:
Phone No. �-�D� C��0—
fT Zip Code: Fax:
� 2 � Phone No. -- 0
'Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: ^ e2001
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION J
i
DESIGNER/ENGINEER: _ of Applicable MORTGAGE COMPANY: ' _ of 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 thepermit 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 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-aNotice 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. s
Xtt7�41�.11�_.4 �
Signature ofn Les e/ oritridr as Agent w --- Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA \
COUNTY OF , COUNTY OF S `
The forgoing instrument was acknowledged before me The forgoing instrument was'acknowledged before me
this,,—gj day of 201a by thisZ4 day of S&j4k 20_Q by
��QAl��ans��,
Name of p on making statement Name of r&r9on making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced rL iQit Produced
VL
ig ure of Notary Publ1 State of Florida) ignature of Notary Pubii State of Florida)
Commission No. J J�1_4!Neaf,�AQNA
Commission Noi� LASHAH�I �
TM�*+r of Florida
Notary Public-S ;MV PUBS'' Notary Puhiic-Stat
My Comm.Expire ;r° }4 My Comm.Expires Dec 20,2018
' FF 177249
lot , ough ti 'N'9l �o�, 1 o h Natio al Notary S
REVIEWS Fa PLANS VEGE Af1Ft� "'� G OVE
COUNTER REVIEW REVIEW REVIEW REV REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17