HomeMy WebLinkAboutBuilding Permit Application ,i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:
Z
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 offline
PROPOSED IMPROVEMENT LOCATION:
Address: g d O b A A E l" r5lurl l,"J
Legal Description:
Property Tax ID#: �- ���- 6� I'y7dy paD 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 nertormed under this permit–check all appy:
HVAC Gas Tank ❑Gas Piping Shutters I]Windows/Doors
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IJ Electric 0 Plumbing Sprinklers Generator a Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
=RY oa,a"
Cost of Construction:$ /;� Utilities: —Sewer❑Septic Building Height:
.OWNER/LESSEE: CONTRACTOR: r
Name C Ades Ve5o Name:
Address:_ J DO 5 3 S wee 7"' Company: ZUW C;lee
City: 1J� PI e/� State:�L Address: 14c c/ '12e
Zip Code: 3 y9q7 Fax: City: F�, 3'e�' i State: rL
Phone No. `7 ? 2- yYaj– cf 3 73 Zip Code: Fax:
E-Mail: Phone No. 772 y
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County iLicense Z
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if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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FSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION !j!
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:
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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 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 accessoryuses 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'Ilender-or an attorney before
commencing work or recording our Notice of Commencement.
Signatur of w essee/Contractor as Agent for Owner Signature Con act ens older
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STATE OF FLORPAi STATE OF FLORID
COUNTY OF J''T liu'cl%c COUNTY OF
The foryLoing instru ent vyas acJ nowled ed before me The for,in instru ent as a=no�wled ed before me
this day of 9 I 20�by this Iday of �7 4���^�' ,20j2 by
--� .�`—�
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Name of person making statement Name of person Making statement V
Personally Known OR Produced Identification e/ Personally Known OR Produced Identification
Type of Identi icationf/ Type of Identi ica ion
Produced d1�C.41 a tf l.t�Gi Produced
(Signature of No aryublic-Stat of�on `re of Notary Pub
,xn"Ry Pu WENDY MATAMO ROS o�"°yp
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aoC� Wemy -state HOS
No Public-stale �I �i ion N I * _ Nota
Commission No. ) (Sfgtlo State of Florida
Commission iY GG 00668 • Commission #GG 000668
,N •~� ''�.F �,.�;� My Comm.Expires Jun 9,2020
9•f oa MY Comrrr Expires Ju 9,2020 , Of Fl
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION;, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17 I
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