HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
z
RECEIVED
�..... _ _. .awT Building Permit Application
Planning and Development Services OCT 2 7 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34.982 Permitting Department
Phone: (772)462-1553 Fax: (772)462-1578 Commercial 119ticl a nb/-, FL
PERMIT APPLICATION FOR:
PROPOSED I,N.PROVEM1EN
T.LOCATI0N , 3
Address: v�� 7�� �� F' 3
Legal Description:
PropertyTax ID#: 5 -,dy' dc�66-dab" 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 [N;FORIVIAT- 10
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Additionalwork to be pertormed under this permit–check all that appy:
_Mechanical _Gas Tank. —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: �(l J 5zl ���� Sq. Ft. of First Floor:
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Cost of Construction: $ 02 41 b 0. v Utiliti s: _Sewer _Septic Building Height:
OWNER/LESS;EE CONTRACTOR:e
Name Name:
Address: )� Company:
City: FeTf i— :,ZDJ State: Address:
Zip Code:--,4/9-t/7 Fax: City: State:
Phone No.77�;?--911)4/6 Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUpPLENiENTAI C NSTRUC7�O LIEN LAW 1NFORMATIOIV
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: - Address:
City: State: City: State:
Zip: j°s -'Phone y Zip: Phone:
FEE SIMPLE TITL'E,HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address Address:
City: s, 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.
Sign ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO A ��- � C. STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-A,-) day of d-7V 20J2 by this day of 20_ by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identif' tion Type of Identification
ProducedProduced
(Signature of Notary Pu ic-St3 ' (Signature of Notary Public-State of Florida)
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M\S$10N# 16,V120
Commission No. ES•Dc��`°enCommission No. (Seal)
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REVIEWS F ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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