HomeMy WebLinkAboutBuilding Permit ApplicationALL 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
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:i
Legal Description: 1 S sc
Property Tax ID #: Q b 500 – 0-2 9,5 —Cr-jo Lot No. !
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
T_
CONSTRUCTION INFORMATION:
Additional work to be Performed under this permit –check all appy:
HVAC Cas Tank Gas Piping Shutters Windows/Doors
Electric 0 Plumbing Sprinklers I Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ A50
S Ft. of First Floor:
Utilities:liSewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name o'v) i 1?
Name:
fir? � rll
Address: V1f
Company:
City: '�{ State: F�-
Zip Code: 1 Fax:
Phone No. �/ ' /� �%5
Address:
a�1
City: 4`
Zip Code:
Phone No.
" State: i -
G 00 Fax:
77'� .. 77 ` 0
E -Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
E -Mail: f )(?, [ 4 [ �q C J " 0(g, cot"
State or County License: L� ,� 9 0 S?_ 0z'
IT value or construction is >zsuu or more, a REGURDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER; Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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, 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 or recording our Notice of Commencement.
5ignat-u a of'Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF U
The for nginstrutnentwasac owledgedpefore me
thin d of 20 10 by
Name of person making statement
Personally Known QK Produced Identification
Type of Identifi on
(signature of Notary Pub _ JJorida ) cnR Im muuU4
} Commission # GG141442
�`�sires: May 4, 2421
Commission No.
Bonded thm kron Notary
Signature o C tractor/License older
STATE OF FLORIDA J,
COUNTY OF
The forg instrum t was ackn ged ore me
this �'S da f <_ by
by
Name of person.ming statement
Oa
Personally Known R Produced Identification
Type of Identificaticwa 7
Produced
Fdk Nag
Si azure ofNotary Pu t* �ftlor llrlmlnn # GG1o1442
BaWi Aar, 2421
ota[Y
Commission No.
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SFA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE.
COMPLETED
Rev. 8/2/17