HomeMy WebLinkAboutBuilding Permit Application I,
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: Permit Number: ���I " 'L
_ - - -_-
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 Residential _
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end ofline
PROPOSED IMPROVEMENT LOCATION:-
Address: 0L_1r\\CA.
Legal Description: �a�✓1� �Ac10-Y- +-( l�\ 3 �� Z�
Property Tax ID#: '3 Lf 19 63o- Q k moa ' Lot No.
Site Plan Name: Block No. `�
Project Name:
Setbacks Front Back: Right Side: Left Side,:
DETAILED DESCRIPTION OF WORK.
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.CONSTRUCTION.INFORMATION:
Additional wor•to be performed under this permit-check all tappy:
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HVAC _Gas Tank ❑Gas Piping _Shutters Windows/Doors
)'S(Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer F]Septic Building Height:
OWNER/LESS'EE: CONTRACTOR" . , z
_. . . _ ��
Name k'C y e.i 1—f ez �tv\ Name: �n� �Jl : moi IiiGL
AddYess: t'IS ( SE �l1n r f-e- Companyr=-C .DOI.!'� jY �5
City:pa r-J- Y__ State:EL' Address: Z�2S *a'L art 3 -ry
Zip Code: 3y 9 3 Fax: City: State:
Phone No. 7 b Zip Code: 3L4 9 L(,5 Fax: z�
E-Mail: Phone No. `�-►Z^`�I ��"1��3
Fill in fee simple Title Holder on next page if different E-Mail: r Ana
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.;
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SUPPLEMENTALCONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:!"' _Not Applicable
Name: Name: i
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:)'i
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name: i
Address: Address:
City: City:
Zip: Phone: Zip: Phone: i
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do thie work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St.Lucie Countty�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 covenantsthat 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.
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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.
Signat a of Owner/Lessee/Contractor as Agent for Owner SignattJ of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA 1 I
COUNTY OF . A, COUNTY OF
The for oing instrupkent was acknowledged before me The forgoing instr ent wasiacknowledged before me
this day of 20M$ by this 1'L3_day of /I 20tL by
; Jul.
Naa of person making statement lame of person making statement
Personally own OR Produced Identification Personally Known I OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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�Ignature of Notary Public-St a of Florida) (Signature of Notary' Pu lic-S rida
LAVAHNIA tl,lGRAM
AM
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—� ,�., :=r ,,tos+4pri,yk, rlic State of Florida ;
Commission No. al.1y1ae�)LASNAHNA�,:GR,4,a `Commission No _�O +° Mytgall_xpires Dec 20.201
ns Notary Public-Stato of Flai , "' °�: COmmission #FF 177249
.'F OFr��: edlh(ough National Notary Ass .
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my Comm Expires Dec 20, 'oi e p y° .•'
Sion� r 1(/21
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REVIEWS' FRONT % ' �qw, ,PLANS VEGETATIO SEA,TURTLE MANGROVE
COUNTER REVIEW RE VIE lel/ '�' REVIEW REVIEW I REVIEW REVIEW
DATE
RECEIVED
-DATE
COMPLETED I
Rev.8/2/17
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