HomeMy WebLinkAbout3023_001ALL APPLICABLE NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
ff Permit Number:
Date: � � I � —._
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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:-- - — =� �S.Q_ L_t- �i A''4"� l
Legal Description: � O hGIA
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Property Tax ID #:`�- Lot No._
Site Plan Name: 1, l,r ,'ti, �C)� l� Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
itso workto a er orme un er this permit — c e
HVAC Gas Tank Gas Piping
2
11 Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
a
U Shutters Windows/Doors
11 Generator Roof Roof pitch
SFt, of First Floor: _
Utilities: Sewer E]Septic
Building Height:
OWNER/LESSEE: _ { CONTRACTOR: o
Name f✓_
Addre s: Q
City: f>tiC C;)1_ State:
Zip Code: Fax: f
Phone
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name; V i V
Company:
Address:
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City a p6t �-cy 4"1 State:
tate Irr f -
Zip Code: �fE L3 Faxes f I i[` l 1
Phonen.
E -Mail: �v1'in C c"
State or County License:
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:_
Address:
City:
Zip:
Phone
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City;
Zip, Phone:_
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone;
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
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.
— �-Navao (�' A't� A&—k-0 9 / 0� �r
Signature of wner/ Lessee/C01
essee/Co raf for as AentJor Owner Signature of ntractor/Licens H Ider
STATE OF FLORID STATE OF FLORI
COUNTY OF COUNTY OF
The foreoing instrj).rneen .was acknowledge before me
this _day of VL'JE -�z0.1 by
Name of person making statement
Personally Known . OR Produced Identification
Type of Identification
Produced
(Signaturlt� of Notary Public -
The roraoing instz ent was acknowledge efore me
this day of — vCt-0 20_� _ by
Name of person making statement
Personally Known _ • C;R Produced Identification
Type of Identification
Produced
(SignatuNof etary Public- State of Florida )
Commission Novi A ?ti z (SJDyCEi,1iCHAUFF O mmission NAT 0930� ?5 v'. S@8
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41 E7tP1RES. Aprik 25, 2018 r ExPfRES: Apel 25, 2018
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17