HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I
Date: Permit Number:
s �
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:
PROPQSED 1N �ROVEMENT LOCATI;+DN. ..
Address:
Legal Description:
Property Tax ID#: 1 a • 5fl Q • 001 • 0002- Lot No. ,i p
Site Plan Name: " Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION DF 1NC►RK
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CONSTRUCTION INFORMATION �� '
Additional workto a per ormedunder this pa.
ermit–check a apply:t at
Mechanical Gas Tank Gas Piping —Shutters Windows/Doors
_Electric —Plumbing —Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer —Septic Building Height:
OWNERj .,
CONTRACT
Name �P ��i ��L �� Name:
Address:c5__7b3 PP(eo Pt /VES Cir Company:
City: State:t7hf t Address:
Zip Code: �� Fax: City: State:
Phone No. ��} n7 i - 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.
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SUMPLEMENTAI CON$TF t CTIC}N� �N
— Applicable MORTGAGE COMPANY: N^
DESIGNER/ENGINEER: Not A licable of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: VPhone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: 'T7V Name:
Address:-S`7 k< P, Address:
City: ' 1 (f-,V,7 City:
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 o tice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for O ner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this i day of OC-_ 20_Q 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 Identification Type of Identification
Produced rC L- Produced
Signature of Notary Public State of Florida) (Signature of Notary Public-State of Florida)
Commission No. A L(&tl)1NA INGRAM Commission No. (Seal)
< iiotary Public-state of Florida
Mv Comm.Expires Dec 20,2018
a,= Commissi n#FF 177249
REVIEWS FR N '�°�""''ZO�11d�hrouphNiPLANS VEGETATION SEA TURTLE MANGROVE
CO RE IG EW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17