HomeMy WebLinkAboutBuilding Permit Application i
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I 1�1 osq
Binding Permit App1i-cation
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:
Address:
G0
Legal Description:
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Property Tax ID#: .3l n -1 y3- 000 -60o v S Lot No.
!Site Plan Name: Block No.
Project Name:
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Setbacks Front Back: Right Side: Left Side
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
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,ional work to be performed under t ispermit-check all appy:
HVAC Gas Tank Gas Piping _Shutters ElWindows/Doors
VN Electric ❑ Plumbing Sprinklers 0 Generator EIRoof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ c2moo. 00 Utilities: Ll Sewer Septic Building Height:
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OWNERAESSEE: CONTRACTOR:
- Name Name:
Address: Company:
City: Stater Address: 0 .I ! /ov
Zip Code: Fax: City: Stater.
Phone No. Is-a 91, 9 Zip Code: Fax: -Qu/-
E-Mail:
u/E-Mail: Phone No. G�
Fill-in.fee simple Title Holder--on-next page if different -E--Mail: 6 eDni ode ¢ii L.r»-,
from the Owner listed above) State or County License: e /300-,58.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _>e Not Applicable MORTGAGE COMPANY. ? Not Applicable
Name: Name:
Address: Address: i
City: State: City: State:
Zip: -Phone gip: Phone:'
FEE SIMPLE TITLE HOLDER: >ClNot Applicable BONDING COMPANY: XNot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:_
-OWNER/-CONTRACTOR AFFIDVFIT:-Application is hereby made to obtain a permit,to dothe 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,
accesso ystr-uctur-e%swimming-pools;-fences,-walls,signs,screen-rooms-and-accessor-y-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 inspectio ou intend to obtain financing, consult with lender or a ttorney before
commencing work or re0brdift your Notice of Commencement.
A)/ Ida ni '.
Sig t e of Owner/L&U,&�/torY6racior as Agent for Owner Signa r of Contractor/Lice se Hol rer
STATE OF FLORIDA !�- STATE OF FLORIDA
COUNTY OF r",�O pa�JA COUNTY OF I �-o��
The for ing instrume t was acknowledged before me The forg ing instru gent as acknowledged before me
thisday of 20 1`t by thisday of 20f2 by
,MiCIN45-L C I,. RT
-Name-of-person-making statement Name-of-person-making-statement
Personally Known ✓ OR Produced Identification Person2lK_no�n ✓ OR Produced identification
Type of Identification Type of Identification'
Produced Produced
/ZL�
(Signature of Notary Public-State of Florida) SSM re of Notary Public-State of Florida)
DAVID RAYM ND
Commission No. V dv�¢ � f-ay.
NOTARY PU Smrriission-No. -SII DAVID RA PRIJ)STATE OF FL RIDA NOTARY P'ULC�FF1 75 STATE OFF O IDA
Cortvr�FF19
rea 1/2 / 19
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEWi REVIEW REVIEW
'DATE
RECEIVED
-DATE
COMPLETED
Rev.8/2/17