HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1- l'1 Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 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 &q t c�da
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Address: ����-� �C'GV N��f C'CN G�-
Legal Description: (-� �C�e P� cyn
Property Tax ID#: Lot No-
Site Plan Name: Block No.
Project Name:
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AdClitionalwork to e nertormeci unclert is permit-chocl all appy:
❑HVAC Gas Tank ❑Gas Piping _ShuttersQ Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: S .Ft.of First Floor: —
Cost of Construction:$y QO 5 „O a Utilities:�Sewer❑Septic Building Height:
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Name(
jy%,�- S Name:
Address: lam[-am) C k'mn Company: "r 2 'C-z1 1-_X r` {JSP•.
City:' -Qk 1\ State:Ft-- Address:
Zip Code: Fax: City: Pbx4-lSk State: r�-
Phone No.`1`1 a1-�"�(- rU�yl Zip Code:.31--LqT1.0 Fax:
E-Mail: --- Phone No. qk'!�10
Fill in fee simple Title Holder on next page(if different E-Maii fl r �� xsp51.
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. h
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DESIGNER/ENGINEER: NoL Applicable MORTGAGE COMPANY: 4&lot Applicable
Name.: Name: _.
Address: /address:
City: State: City: State:
iip:, Phone.... ....... zip: Phone.:
FEE SIMPLE TITLEHOLDER: YNotApplicable BONDING COMPANY: V__)Not Applicable
Name: Narne: _
Address; Address:
City: City:___...... -'--
Zip:_—_ Phone: -Lip:. Phone:
OWNER/CONTRACTOR AFFIDVIT:AppliCafion is hereby made to obtain a permit to do the word ancd installation a s indicated.
I certify that no work or installation has commenced prior to the issuance.of.3 permit.
Sl.Lucie County rnakes no representation that is granting a permit will authorize the permit holder to build the subjeel sli uClur'e
which is in rontlirt with arty applicable I IorTle Owners Association I UIeS,bylaws or and covenants that may restrict or prohibit such
structure.Plcasa conSUlt with yor.u-Home.Owncl,Association and review your rdend for any restrictions which may apply.
In consideration of the granting of this reque.ste..d permit,I do hr.reby agar.?that I will,in all r(-.,.spects,preform thr,work
in amoidance w0i the approved plans,the Florida&rilding Codes and St.Lucie County Arnendrnenls,
The following building perrl)il appli0Lioi)S are exernpl from undergoing a fill ConCunency review;room additions,
L'ucessory structural,swimming pools,fencer,walls,signs,sacr.n rooms incl acre.ssory uses to another non residential Use
WARNING TO OWNER:Your failure.to Record a Notice of Commencement may result in your Paying twice for
improvernenLS Lo your property.A Notice of Cornmencernent must be recorded and posted on the jobSile
before the first inspection. if you intend Lo obtain firrarrcirle.,corlSUIL with lender or an attorney before
--mmencin Y work or recording our Notice of Commencement.
Si nture of Owner/Lessee Contractor as Agnni for own(?r Signature?of C:onim(%lifi I ir.i�libR I lold(?r
STATE OF FLOIt�pA STATE OF FLORlp
COUNTY OF .��' l��C _,_.. COUNTY OF�7
The8l;ping inArrUffleenL was acknowledged before.ma The II' ,oing insl unienlwas accnowledged before rn
I'his CZ ll;iy of ,_b, �ji'�1 ZO «by this 7_� day 01 �i� ' ?_0 (�)by
Namn of pctso making stalern,?nl Name.of per,on eking statement
Personally Known—. OR Produced Identification — Personally Knower ` OR Produced Identification
I•ype of Identification Type of Idenlilir..alion
Produced Pmdurnl
(SiLnalur'e of Notary Publ c State of I lorida) (Signature.of Notary PublicAtata of Florida)
.,asY npyvc l'IFFANY A.Ltt ,�,ouy np6,
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Currlrrrission No.F�� 4F'krl:I)MMISSIONVFF101474 Commission No. ( �„ `cal
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FXPll IFS:April z6,2a I II 4„ � i xPlrlr-s:A
'R�FF`�es BudrrfliuuBudgeiNniyuurvlce9 '�s •c)," 11oM(dlhfuBud4P. • . t
REVIEWS FRONT ZONING SUPERVISOR PLANS VF.CF.TATION SFA TIIRTI F MANGROVL
CoLINTER REVIEW REVIFW ftl-VII-W RLVILW REVIEW REVIEW
DATE
RLCLIVLD _
DATE
C:()MPLL-ILL)
Rev.8/7./'17
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