HomeMy WebLinkAbout3017_001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �Permit Number:
r
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 LOCATIO :
Address:
Legal Description: Li
Property Tax ID #: W - l Lot No,�I.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: _ Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: 1
ac
CONSTRUCTION INFORMATION:
Adcliflpfra work to berorme un er is permit - check aii appy
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator L1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
f (I
OD 0 0
Cost of Construction: $ Utilities: Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name l�.IL�} - �.' Name: �l►�-
Address:- °�� Company:
City: Stater Adress:���
Zip Code: Fax: City: JUNL:) c.c.- _
Phone No. Zip Code: '" � � Fax Nft
E-Mail: T_ Phone No -_N_4(->
Fill in fee simple Title Holder on next page ( if different E-Mail: ►n-�+ Lt
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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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:
City:
Address:
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.
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Signature of caner/ Lessee/Co r for as A en or Owner
Signature of ntractor/Licens H Ider
STATE OF FLORIDIk
STAVE OF FLORI
COUNTY OF Q
COUNTY OF \1UL-
The forgoing instrAmert was acknowledged before me
this .� day of _C , 20_, by
The Fo going instz enr was acknowledge fore me
this a day of ,L X120 by
Name of person making statement
Personally Known y OR Produced Identification
Name of person making statement
Personally Known � OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signatur of N tary Public St I❑ride
(Signatu of tary Public -State of Florida )
ay S,,��Iy�� JOYCEMICHAUD
Commission N ,;( iAOMMISSIONIFF0 3006
1'�� =EXPIRES; April 2S,2018
Thti HilaPuhl: lly.
mmission NAT08,3o 4 r Sea
i' ( CPMICHAUD
:+ .4g MY COMMISSION FF 08800fi
EJ(I'IRES: April 25 2018
' �r �r]AidQd ThTu i ei11Hb:W'REVIEWS
ONING SUPERVISOR
CEVIEW REVIEW
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED � ��-
Rev. 8/2/17