HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` Permit Number:
Building Permit Application
Planning and.Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 I'
Phone: (772)462-1553 Fax: (772)462-1578 Commercial II Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the e`hd ofline
PROPOSED IMPROVEMENT LOCATION:
Address: 5� ";!!:5
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Legal Description: I!
Property Tax ID#: Lot No.
Site Plan Name: Block No./2192—�;
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: II {i Il
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CONSTRUCTION INFORMATION: �►� ��,
Additional work to be performed under this permit—check all that appy: �I I
HVAC Gas Tank Gas Piping _Shutters
p� g �I�I Q Windows/Doors
Electric Plumbing Sprinklers Generator �! i Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities:cnSewer Septic I Building Height:
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OWNER/LESSEE: CONTRACTOR: I`$h
Name ` Name: S'�✓
Address: �O tiCj 5� _ Company:
City: tha Stater( Address:
Zip Code: Fax: City:, State R_
Phone Nro. �2 I�� '�.� Zip Code: c3 . i! ' Fax:
E-Mail: 6! Phone No. .7Yg`. 7,*
Fill in fee simple Title Holder on next page(if different E-mail:n , i , y
from the Owner listed above) State or County License:
I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION IIEN LAW INFORMATION:
DESIGNER/ENGINEER: of ApplicableMORTGAGE COMPANY:, `Not Applicable
Name: Name:
Address: Address:
City: State: City: .I I''+ State:
Zip: Phone Zip: .1 Phone,-.'
FEESIMPLE TITLEHOLDER: K7Not Applicable BONDING COMPANY: 'I' 11 L Not Applicable
Name: Name:
Address: Address: l
City: City:
Zip: Phone: Zip: Phone:i
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. l'
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,Wall 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 an,0ther 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
commencin ork or recording our Notice of Commencement. I f
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Signature of wner/Less /Contractor as Agent for Owner Signature of Contracto nse Holder
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I!STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 4SA ,9 -c.o COUNTY OF
The for oing inst ument was acknowledged before me The forgoing instru nt was acknowledged before me
this 4 day of�__�20_n by this S day of 4 c+ 1 ,2t) by
Name of per making atem nt Name of person akin„ tatement
Personally Known OR Prod uced.ldentification Personally Known i OR Produced Identification
Type of Idv�ification Type of Identification }
Produced-J( Produced 1, � fti
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(Signa ure of Notary Public-:State:. fCFlorida- at uag ,j d
(Signature
SI nature of Nota Publi -St, to of-Florida_„_ ^s
euo+leN g6noaUl P 3�,�, I ,,,n,,, LASHAHNA INGRAM
uss GIQN ;
Commission No. ssza i��#uols.�, 1 _ •_ Commission No. c°�: �`�. 0eal)tlblic State of Florida
91.0"0Z as
p sa�tdx3'm � z *z - w', hU; �ryy Comm.Expires Dec 20,2 9
aIpIS-ollgnd fleloN ' ,',enrr�+�;o`' " ` °o"c Commission#FF 17724(
Epil0lj ml H Sd1 ��._�111`0 I ''ifF c °:�` atinnal afv a
REVIEWS FRO�iI' ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW i +REVIEW REVIEW
DATE I
RECEIVED
DATE
COMPLETED
Rev.8/2/17 j
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