HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l' 1?z>` Permit Number: ��/ �• "I
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Building Permit Application NOV 13 2017
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 «L,
PERMIT APPLICATION FOR: ����� ( }�� 54- 1 ty G L r✓
PR(3POSED PRO
IN. VEMENT LOCATIt?N
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Address: a ���L r--i.
Legal Description:
Property Tax ID#: D10 3 s �1 _ 'J a J�_ 'a o – S Lot No.
Site Plan Name: lI Block No.
Project Name: P Y n
Setbacks Front Back: Right Si Left Side:
DETAILED DESCRIPTION C)F WORK
2
CQNSTRUCTION INFORMATION
Additional work 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: � Sq. Ft. of First Floor: .
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
O1IVNER/LESSEE ; .. ._. : COIUTRACTOR
_A
Name Wl�l-f�� �RI Name:
t--1 � Company:
City: LS State: FL- Address:
Zip Code: Fax: t-6 City: State:
Phone No. `i ��- �"-S- Zip Code: Fax:
E-Mail: U kc$ I "-C C'Oy'1 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.
i
SUPRLEMEIVTAL C41US1'I2UCTION LIEN LAW I,NFQR„MATIQN
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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 thepermit 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 fo Ow"rrr'` Signature of Contractor/License Holder
W
STATE OF FLORIDA g STATE OF FLORIDA
COUNTY OF 2�s COUNTY OF
o
The forgoing instrument was acknowledged before z The forgoing instrument was acknowledged before me
this day of_,�l r. 20-by this day of 20_ by
ov m
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Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Iden iif 6 ion ` Type of Identification
Produced Produced
(Signature of N V ffublic-State of Florida ) (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17