HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /02 - / 7 Permit Number: �o� • � �
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Building Permit Application DEC / 4 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P'RDPoO tl -WPROUEMENT LOCATION
Address: S,?6) 6 5lJ!!S PT R
Legal Description:
Property Tax ID#: 3 6M l ' 0 L O.5-0 S_ d 0 0-Tr' Lot No. PF
Site Plan Name: Block No.5
Project Name: T .,) C�LjCt'_c� 11ft ✓�'�'' S T f�PT
Setbacks Front Back: Right Side: Left Side:
�DETAILED,DESCRIPTICI!%, WORK
5 (,� Geo Cus
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CONSTRUCTION INFORxMATIQN k ,
Additional wor toe ertormed under this permit-check all appy:
❑HVAC Gas Tank Gas Piping Shutters Windows/Doors
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❑Electric 0 Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ L�L��6 r �i Utilities:Sewer❑Septic Building Height:
OWNR/LESSEE ,
CO
ENTRACTOR
Name (5 L1 -A (&�D tI f f Name:
Address: 5-3 D 6 Suk- e-7- Company:
City: F.i. State:F1 Address: T
Zip Code.3J-1 V Y:'�- Fax: City: State:
Phone No.7 6,,7�'7 Zip Code: Fax:
E-Mail: W 0Lfe5'j7c_c k `Gt2 gra,`L 4!f 0/— 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.
S_ 'PPLEMENTAL'CONSTRUCTION LIEN LAW MATION k
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: 11
City: State: City: VState:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: J 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 o tairaJcing, consult with lender or an attorney before
commencing work or recording our Notice i' ncement.
Siknature of Owner/Lessee Contractor as Agent folped Signature of Contractor/License Holder
SE OF FLORI _ STATE OF FLORIDA
�COF cc ` ` COUNTY OF
i � �C-
The forgoing instrument was acknowledged before
�T s The forgoing instrument was acknowledged before me
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this_day of 2011 by this day of 20_ by
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Name of person making state nt Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Id nti ' ation Type of Identification
Produced C Produced
(Signature of NotaryP blic-State of Florida) (Signature of Notary Public-State of Florida)
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
Rev.8/2/17