HomeMy WebLinkAboutBuilding Permit Application I `
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ' i 110 'vu�J!
Sig 101 a
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 of line
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PROPOSED„IMPROVEMENT LOCATtO
Address: U 0(22 `r;'AQ_fN VJ00 c`
Legal Description:
Property Tax ID#: 2-I ^^ 02_ " na35 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: I
DEl'A(tED DESCRPTIION y WORK
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CONSTRUCTI " INFOR
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Additional work to be nertormeci unclertnispermrt—c ecaMhuttprs_
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HVAC Gas Tank []Gas Piping a Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Utilities. —Sewer 0 Septic Building Height:
CONl'RACOR777T7, ✓y
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Name 1 C;l SAX) VT\ Name: CV x6L\.JG V IrS
Address: (�`� &rAk,4N1J Company: C
City: r'�s lli/'CSL Stater Address: o
Zip Code: C.99 2- Fax: City: :Q2 —V c-ePC_2 State:
Phone No. Zip Code: �q'yo Fax:
E-Mail: Phone No. Z c—�, —�-+ 1
Fill in fee simple Title Holder on next page(if different E-Mail: ���G��sJC:C1�'Lt�S T 1 Op 6TmQ
from the Owner listed above) State or County License: I '! C)6 ro
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPIEMENTAL`CNSTRUON LEEN LAW INFORMATION' �
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone: i
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 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 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 of Owner/Lessee/Contractor as Agent for Owner Signature of Contra ctor/Licen'se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S-t1.�,S lta COUNTY OF
The forgoing instrent was acknowledged before me The forgoing instrument was acknowledged before me
this 14S day of 20 J'? by this day of 20_ by
Nam4 of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ";-�L Produced
(Signature of Notary Public-Sta of Florida) (Signature of Nota{y Public-State of Florida)
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Commission No. (Seal) mission No. (Seal)
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LASHAIiNA
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lilyCo m.Expisei FF i77'.�tiy ,
REVIEWS FRONT jN: G con AsRIL NS VEGETATION SEA TURTLE MANGROVE
COUNTER r � WgcedeI 1hraRE_V.IE1N.= sREVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED -
DATE
COMPLETED
Rev. 8/2/17
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