HomeMy WebLinkAboutBuilding Permit Application I`r I
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ALL APPLICABLEJINFCY MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:� / � Permit Number:
- wilding Permit Applicati 1 n h
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Planning and Development Services o
Building and Code Regulation Division I
2300 Virginia Avenue,Fort Pierce FL 34982 j
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resident al _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end ofii line
PROPOSED 1MPROVEMEN7 LOGATIORIVi
Address: �� 7 /�'I�,f/4/h. AAa', �' I
Legal Description: 36/1,r-; ' by
Property Tax I#: �13[� 00��` 000- Lot No.
Site Plan Name: I Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side' I
?`DETACLED DESCR}IF WOPTIONORK # '
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CCNSTft11CTl0f CNFQRMATION: z
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dditional work to be nertormed under tispermit—check all tbatappy:
aHVAC _Gas Tank ❑Gas Piping Shutters Windows/Doors
,Electric ®Plumbing Sprinklers ®Generator L :=1 Roof Roof pitch
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Total Sq. Ft of Construction: Sq. Ft.of First Floor it
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Cost of Construction: $ /;)—/;)—oz)- Utilities: 0Sewer Elseptic Building Height:
01NIVERjLESSEE rCONRACTOR
Name i r— r►1," Name: _ wl
Address:��// . 7 s / 0/— Company: o it
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City: -t-T, i fir' r State:� Address: 74 9 �i i
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Zip Code: 3417 B � Fax: City:s-T• Pl�1 State'.
Phone No. 77 2- (7 2- 2,HO Zip Code: YX/9 ��� Fax:
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E-Mail: Phone No. -7 : p
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
Llue of construction is$2500 or more,a RECORDED Notice of Commencement is required. '
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SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFC3RMATION jE y , P `�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMOANY:J Not Applicable
Name: Name:
Address: Address:
City: State: City: it State:
Zip: Phone Zip: Phone:!
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City: it i
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit too do thawork and installation as indicated.
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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 restn'ctions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,p4
form
form the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County AendmE�nts. i
The following building permit applications are exempt from undergoing a full concurrency l review,roomiadditions,
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accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory usIes to another non-residential use
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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 Trend posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender a'r an attorney before
commencing work or recording your Notice of Commencement. .
Signature of Owner/Lesst-cWt—ra cto r as Agent for'O�er Signature of Contractor censfe Holder
STATE OF FLORIDA STATE OF FLORID k I
COUNTY OF <-t [,mac. COUNTY OFT, c�
The forgoing instrument was acknowledged before me The forgoing instrument wasi,a'cknovyrledged before me
this_kf day of :,:)ecer-_. 20 I this_aL day of
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Name of person making statement �,,a..��m, Name of person making statement ^0�
Personally Known ✓ OR Produced Id �i11C�tia�' Personally Known OR;Produced Identifi tfab;, d o
Type of Identification 3 $ Type of Identification z
Produced o o d Produced i_ r.
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3 c S v
X _ H v
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(Signature of Notary Public-State of Florcore
ida T T E: (Signa ure of Notary Public State of Florida) '� H c
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Commission No._�1– OR.Qf J {Se ) N o Commission No. K; b9 ( cc
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION j 'SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ! REVIEW REVIEW
DATE
RECEIVED t it
DATE
COMPLETED
Rev.8/2/17 i
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