HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 'Q J
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division i
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR: To Select from dropbox�, click arrow at the end ofline zs
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;Legal Description: YU I I rML&J S 1 Q 3 L-0 -S G Yl�
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Property Tax ID#: o`ZC��(� — 0 D 0�,S`�(0(� Lot No.
iSite Plan Name: Block No.
Project Name: �,l'1 an ®� h. 11 �s
Setbacks Front Back: Right Side: Left Side
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Additional work to be Derrormed under tis permit—check all tbat appy: } °
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I�HVAC Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric Plumbing Sprinklers Generator I Roof �2 Roof pitch
Total Sq. Ft of Construction: /0 o D g Sq. Ft.of First Floor:
Cost of Construction:$ ® s��O Utilities: Sewer Septic Building Height: S
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Name malC> �j-i (-..�J"i'1 �f S l�(� Name: 73)04 S 06,ln
Address: I q N W a- Company:
City: ?_LYM�M n n Stater Address: S �� lv i-(
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Zip Code: 3-3 D Co9-' Fax: City: cel, te:_L,
Phone No. -7 T2-
Zip Code: Fax:
E-Mail: Phone No. '1'72 4 3 ,`-Ci
Fill in fee simple Title Holder on next page(if different E-Mail: r:I (bD
from the Owner listed above) State or County Lice (2r I �� 2,<) _S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.,
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SUPQLMENTALiC_ONS�TRU "ION, LIEN'LAUU
ClINFQRMATION r <� � rR ��' F' }
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPA'Y: ' Not Applicable
Name: Name:
Address: Address: i
City: State: City: i State:
!Zip: Phone Zip: Phone:
IFEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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.
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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
i�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 uses1to 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 or recorOng your Notice of Commencement
SignatLoWwOner/Lessee Contr for as,Agent for Owner Signature of Contractor/Licen older
STATE OF FLORID STATE OF FLORIDA
COUNTY OF (/!Qi COUNTY OF S4 . CL�
The forgoing instrurjwnt was acknowledge before me The forgoing instrun entl was acknowledged efore me
this 12Yay of_ 20 by this 11dlay of 11a 20 by
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Name of person making tatement Name of perso10making statEbent
Personally Known OR Produced Identification Personally Known L4 OR Produced Identification
Type of Iden 'ficption r Type of Identification I ! I
Produce ProducedAV
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(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Commission No. lic&NlOf Florida Commission No. (Seal)
Jennifer Davis �tqntary
My Commission FF 966029
Ex ires 02/29/2020 _MtPublic State of Florida
JenniferDWIn F 986029
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGET I � ZQ' MANGR E
'COUNTER REVIEW REVIEW REVIEW REVIE o►«�
DATE
RECEIVED
DATE
COMPLETED i
Rev.8/2/17
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