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 C4 C -i Ln n(--,,
Legal Description: C of x'Cl-i t� l \) I n C `, iffs-h :.� - s � K B �.a-r it
Property Tax ID #: ra'i - per} .-5
Site Plan Name
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No. ii
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to(ever orme under this permit- check a appy:
HVAC (=.! Gas Tank Gas Piping Shutters Windows/Doors
RElectric ElPlumbing Sprinklers Generator _ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ .00
Sq. Ft. of First Floor:
Utilities:Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name Mo I,L`'s_sa �r1i`
Name: bao Id LaVMe
Company:-I:be Cli,QtSS Proms
S i 0101 S
Address: )iD l 5NN BkAS�l lm LC311 e,
City: 'Tor- -f. Lk 0 j -P State: EL_
Zip Code: 3 4qP Fax: (
Phone No. -J 7c3 - 995 " <`a �,
Address: ZE70, c'(" 1)iX k—
City: 7 1I"
Zip Code: -Z)qq Fax:
Phone No. -77a-
--J V 11`
Stater
j
E-mail: rata C . CCS i"n
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail:
State or County License: 1
" c
If value of construction is $2500 or more, a RECORDED 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:
Address:
BONDING COMPANY: Not Applicable
Name:
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 your Notice of Commencement.
Signatof OwnerfLessee/Contractor as Agent for Owner I Sign
Holder
STATE OF FLORIDASTATE OF FLORIDA �tt�
COUNTY OF t' rAY-� � n COUNTY OF M Gtr+)I I—)
The forgoing instrument was acknowledged before me
this day of j Q IJJ.A -(. t, 20j—P) by
Ci e
Name of person u4king statement
Personally Known V OR Produced Identification
Type of Identification
Produced
r
(Signature of Notary P ic- State of Florida )
Commission No. -''SPRY Pie; (SeagLLY WIDMAN
Notary Public - State of Florida
* Commission # FF 929255
REVIEWS I FROKT®
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The forgoing instrument was acknowledged before me
this — day of J Q 20 by
Cad'. �
Name of perso aking statement
Personally Known OR Produced Identification
Type of Identification
Produced
(Signature of Nota Publi tg of Florida )
ssion No.
" Bonded thro gh National Notar4
PLANS VEGETATION
REVIEW As REVIEW REVIEW I REVIEW
�PAN
N tarySeaublicELLY WIDM- State of Flo,
commission # FF 929255
REVIEW I REVIEW
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357 S.E. Dixie Highway -Stuart, FL 34997.7)2 6-0459 - g[assprofessionals@gmait.com