HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL 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 Horne 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 1 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
commencinE work or r -e -e4niz your Notice of Commencement.
Rev. 8/2/17
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORID
STATE OF FLORJDA
COUNTY OF SA-. " L\
COUNTY OF
The forgoing instant was acknowledged before me
20 by
The forgoing instrument was acknowledged before me
this day of G.y4 20A by
thisday of ��Co _
i
Name of person making statement
Name of per on making statement
Personally Known OR Produced Identification
Personally Known A OR Produced Identification
Type of Identification
Type of IdentificAtion
Produced
Produced
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REVIEW
REVIEW
REVIEW
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REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I k25111 !E Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial
Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I 'PROPOSED IMPROVEMENT LOCATION:
Address: l- ► s`
Legal Description CQ - i� C
Property Tax ID ##: _�)Lot No.
Site Plan Name: Block No.
Project Name: Rid IS
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Additional work to be Dertormed under this permit - check an appry:
HVAC Gas Tank OGas Piping Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator � Roof Roof pitch
Total Sq. Ft of Construction:-) -15 1� 5 Ft. of First Floor:
Cost of Construction: $ 1 i`� _ U Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
6
Name uAN �4y15
Name: -hCtiS�`@r1�Se)c\
Address: 1D 0_1
Company:
City: ; C State:
Address: cs n
State
Zip Code: 6 Fax:
Phone No. Tl -1 DL - '-} 41-y - "]
Zip Code: -�_"q c Fax: o`
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Phone No. : C5'6 - ��1 '� - r" 3
Fill in fee simple Title Holder on next page ( if different
E -Mail: r xnw� - cx- t�
from the owner listed above)
State or County License: alp �)' t✓"
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.