HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�.
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
PROPOSED IMPROVEMENT LOCATION: .
Address: AGoo -5, LA_S1 �eocu ST (,�c�E H�SZ 5�,t'�
Legal Description:
Property Tax ID#: 'J`� 1`� — 5� �10 �� d00 �� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
EPcvac SF'c- ysr-rv-. AlC
CONSTRUCTION INFORMATION:
itiona work toe e orme under this permit-check a appy:
HVAC E]Gas Tank ❑Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers 1:1 Generator E]Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ /D, acsv Utilities: _Sewer E]Septic (Building Height:
OWNER/LES$.EE: CONTRACTOR:
Name 'moi "P Name: _. )-F 6'e"",A1zI
Address: 350 1JI6-uNcsre-f- St-- Company:
City: Lower 6"TruLio - State:&P Address: 3511 N'E Z,Lp Rue-
Zip Code:M�4 gS41 Fax: City: Stater
Phone No. Zip Code: Fax:
E-Mail: Phone No. 52.P/-702 -off
Fill in fee simple Title Holder on next page(if different E-Mail: 9,41.0: Oc rLL! Ca C EH A�4S.Co�-�
from the Owner listed above) State or County License: c- 37L'Jr
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: `
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 reviewdroom 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 o'r an attorney before
commencing work or recording our Notice of Commencement.
,-„
Si ature of Owner/Lessee/Contractor as Agent for Owner Signgure of Contractor/License Holder
i
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF _4L .r.«
The forgoing instrufnent was acknowledged before me The forgoing instruAnent was acknowledged before me
this day of � � 20L by this L—day of
p 20L-L- by
Na a of person making statement NarAe of person making statement
Personally Known `—�OR Produced Identification Personally Known ----_0R Produced Identification
Type of Identification Type of Identification I
Produced Produced
re o otary Public-State of Florida) (Signature of Notary Public-'State of Florid
'lo-,rtn6iiio�0'DRi
(Seal) Commission No.
sa F-I•a�v�'�iss� F� cg �'�'`
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REVIEWS fvb� ONING SUPERVISOR PLANS VEGETATION SEAT E MANGROVE
C TR REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17