HomeMy WebLinkAboutBuilding Permit Application I
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: /0-/,/-/7 _ 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 4 /
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'LOCATI ON
Address: [� 0
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Legal Description: " ur D6 i��� ��.�- � / f- +^n Vil°I_Iy U.41* /a
PropertyTax lD#: q �,y- &05�- E°��' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK .
P_.ey9)&C i ry I&')c7 (vtc7 j-
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CONSTRUCTIONINFORMATION
Additional work toe e orme under this permit-check a appy:
EIHVAC E]Gas Tank as Piping _Shutters Windows/Doors
Electric ElPlumbingSprinklers ❑Generator I Roof Roof pitch
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Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 3yi'� ® 0 0 Utilities:'nSewer OSeptic 'jLiiding Height:
.OWNER/LESSEE;
CONTRACTOR;;
Name Ot ` s Name: J6,1's LeIO -1 Z
Addres : o,?p z)w 2_® .v,./ 1'n Company: l � c�%fi;��oF'
City: lM 6s _X State: / Address: 7 SW
Zip Code: Fax: City: L-icc r State:�L
Phone No.(7 zp 3X&- /&S- Zip Code: J k9Y3 III Fax:
E-Mail: Phone No. y7,P) 2';;'0"
Fill in fee simple Title Holder on next page(if different E-Mail: v®v' ° e, PC .C`')
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN_LAW IN;FORIVIATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:
7Address-:�EE����� Address:City: ter City. State:
Zip: Phone Phone:
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FEE SIMPLE TITLE HOLDER: of 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 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:,doom 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 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.
Signature gff Owner/Lessee/Contractor as Agent for Owner Signature of Co ractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF
Laie— COUNTY OF
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The fofCgoing instrume t was acknowledge efore me The forgoing instr ent as a"knowledg efore me
this- I day of , 0C'r� 20 y this J4 day of L2014by
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erson making statement am�son a rig statementersonally Known OR Pr duced Identification Personally KnOR Produced Identification
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Produced Produced
(Signatur"f' Public-��AMWiEla) (Signature of Not Public-4-W Flor"id3)' ;
Notary Public-State of Florida
° '" Commission# FF 2 Notary F. `lorida
Commission No. ° �Bis� Commission No. ��.° (Seal) t30
;,; My Comm.Expires May 27,2015 ���,•: iComm ,2019
° Ecndedthrough National Notary Assn.
MyComr
R nnded Us ,Assn.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
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COMPLETED
Rev.8/2/17
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