HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L._Ll 17 Permit Number: / /I/ ' vim"
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Building Permit Application
Planning and Development Services NOVBuilding and Code Regulation Division N 201i
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: dip
PROPOSED INPROVEMENT LOCATIQ�N � F�
Address: /-7qb 9foW61c / yQ-t h6oecE FL .3194 946-
Legal Description:
Property Tax ID#: �� fl�- �� 0 J Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEQ DES:CRIPTIQN.aF,WQRK
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CONSTRKTIQIV INFORMATION �j
Additional wor to be pertormed un er t is perm,,E-cneCK all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof 12- Pitch
Total Sq. Ft of Construction: �1 000 Sy Sq. Ft. of First:Floor:
Cost of Construction: $� D� Utilities: —Sewer —Septic Building Height:
ODUNER/LESSEE CC}NTRAC 'OR.'x
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Name 66,p-— -&4 Name: 66.lLT {4(00,2�
Address: /7440 Sic+Va1Wv1 ��.4C Company:
City: /t7 /01 a,Q.C4 State:- Address: / 74�9 SZpfi/y',
Zip Code: 3tJR0-,5__ Fax: City: 64ex_- State: 1-7-Z-
Phone No. '7-7,;Z- 44-x— &2-01 Zip Code: Fax:
E-Mail: Phone No 772 -4- S 6;->Dj
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
Le of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPI.EIVIENTT CQNSTRUCTI0N LIEN LAW-INFQRMATIQN
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 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
commencingwork or recordingour Notice-off mencement.
Signature of Owner/Lessee/Contract as Agen :=:rte BE f Signature of Contractor/License Holder
w-_LD I
STATE OF FLORI �� � _ ;� STATE OF FLORIDA
COUNTY OF COUNTY OF
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The f r ing instrument was acknowledged of re Vie„ The forgoing instrument was acknowledged before me
ro,
this day of ,� 20//�'-b,� , `�: this day of 120 by
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Name of person making statement. Name of person making statement.
Personally nown OR Produced Identification Personally Known OR Produced.Identification
Type of Identificati ii / Type of Identification
Produced Produced
(Signature of Noar Public-State of Florida (Signature of Notary Public-State of Florida)I
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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