HomeMy WebLinkAbout8001 Lakeside Way Ft Pierce Permit ApplicationALL APPUCABLE IE
COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r}d, ll Permit !Number:
gill
Building Permit Application
Planning and Development Services
Building and Code Regulation Division ///
2300 Virginia Avenue, Fort Pierce FL 34982 14
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
P'E'RMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of I
PROPOSED IMPROVEMENT LOCATION:
Address: i I Li I j f�-,_o
Legal Description:
Property Tax ID #: '' "" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
E
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to e e Orme under t ispermit - c""
a apply:
Gas Piping _ Shutters Windows/Doors
�IWVAC Gas Tank
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ _ Utilities:n Sewer 0 Septic Building Weight:
OWNER LESSEE:
CONTRAC R:.
Name
Name: a
Address: I LQ
Company: 1
City: r i State _
Addre
Zip Code: Fax:
City: A, state:
Phone No.
Zip Code: Fx:
E -Mail:
Phone No.
Fill in fee simple Title Holder on next page (if different
E -Mail: I n Lk , e�
from the Owner listed above)
State or County License: to
11 value ur Lunst[ruumn is ?4ouu or more, a Kt4VKUtLJ Notice of Lommencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
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 recor&na vour Notice of Commencement. . .r
Rev. 8/2/17
Si tore of Owner/ Lessee/Contracto s.Agent for Owner
Sig re of Contractor/ icense Ho der
STATE OF FLOR,I#�I/�
STATE OF FLO�
COUNTY OF i /
COUNTY OF i
�
The f going instru e w
acknowledg fore me
The f Ing ins ru w
acknowledge efore me
thls,� day of
y
thi day of
20 by
Name of per on ing statement
Nia
Name of p rson
ing statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of No
orf
Commission No. J 044"t
Notary Public State of Florida
DianrwKnight[S l]
OSW
(Signature of Notary Public- State of io)ida J
a Public all brida
Notary
Commission No.W'.
y a
y omfnissinir
Sxplrea g512117tl21
Dianna Knight
My Cornmieatan GG 09896e
Ee.0 . o5J2fM102f
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17