HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12 n 7' I Permit Number: I`� ) 0 �S
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Building Permit Application
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Planningand Development Services
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P 2017
Building and Code Regulation Division
2300 Virginia Avenue, FortPierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential / 1
PERMIT APPLICATION FOR: 9 ,bl)JO61
(TIJ R1'
PRQPaS.ED INPROUEMENT ll3:CATlt}�1 .
Address: 3 F--t P,�� Z
Legal Description:
Property Tax ID#: 2 �33 1YI 0 o p Z — 0 oo— 2 Lot No.
Site Plan Name: I, Block No..
Project Name: uh,w 11l o D K_..U.D
Setbacks Front Back: Right Side: Left Side:
QETAiIl.ED QESCRIPTiON OE WORK
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CONSTRUCTIQN lNFORMATI�N
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Additional wor to be pertormed under this permit—checK all that appy:
_Mechanical _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:$ S-C� . °p Utilities: —Sewer —Septic Building Height:
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OWNS /lEssEE
CONTRACTOR
Name 71m 1 G Name:
Address: L ( Company:
City: kt PefL- State:% Address: �t' '(
Zip Code: q. ' L Fax: City:��"_ P1 PSL[_ State:
Phone No. IJ L., Zip Code
E-Mail: 11 ( Phone No •�1 7,- 5, Lb 93 b
Fill in fee simple Title Holder on next page(if different E-Mail Led 1 li`i uo nA If 1.1—(','Oft net
from the Owner listed above) State or County License C h�C 95-yz
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTA(. CONSTRUCT N11 ENLAW INFORMATION
..
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
V
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 oC.-recording vour Notice of Commencement.
Signature of Wier/Losselpon for as Agent f f Qyr Pf i; Signature of Contractor/License Holder
STATE OF FLORID " '=.f:, STATE OF FLORIDA
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COUNTY OF ? r i'° COUNTY OF
The forgoing instru ent was acknowledged beforeNe-D The forgoing instrument was acknowledged before me
this iday of E' 20� by this day of 20_ by
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(Name of person ack owledgin (Name of person acknowledging)
(Signature of IV
ary Public,State of Florida V V (Signature of Notary Public-State of Florida)
Personally n OR Produced Identification Personally Known OR Produced Identification
Type of Identificati Type of Identification
Produced C _ Produced
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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