HomeMy WebLinkAbout3029_001ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: <` Permit Number:
:.
- 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:
Legal Description:
Property Tax ID #: `Ub n -(:m-
Site Plan Name:
Project Name
Setbacks Front Back: _. Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
CONSTRUCTION
to-b--'r o rm ed un d e th ipe ermit — e
�j
HVAC L _I Gas Tank E]Gas Piping
11 Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 6�
Lot No. :.D.
Block No, I. LS
��X I b�(_ �,k3
apply:
Shutters ❑ Windows/Doors
Generator 11 Roof Roof pitch
5 Ft.
of First Floor:
Utilities: I_I Sewer[] Septic
I OWNER/LESSEE: 1 CONTRACTOR:
Name 'C
Addre :
City: State:
State:—
Zip Code: "lS Fax:
Phone No
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name:
Company:—
Address: �'' •C .2 k
City. State:
Zip Code:Falx -N::�Q-'
Phone Noll��-a" J�
E -Mail:
State or County License:''�� �v
If value of construction is $2500 or more, a RECORDED Notice of Commencement 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 recording our Notice of Commencement.
A A
AL9
essee/Co r for as A en or Owner Signature of ntractor/Licens H Ider
Signature of caner/ Lessee/Cot
STATE OF FLORID STATE OF FLORID
COUNTY OF��Nf\ q�J L� COUNTY OF
The fo s{oing instr e t was acknowledged before me The forte ing inst✓!u n was acknowledged efore me
�C1
this r day of +� 2D_� by this'' day of ( 20_, jby
Name of person making statement Name of person making statement
Personally Known .� OR Produced Identification Personally Known t_---__0R Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signatur of N tart' Public- St t lorida (Signatu of h tart' Public- State of Florida )
Commission No, - (SidYCTih1M15SI01VtiFF083008 mmission NAT , y,€r. Sea
VV P��f-�-J�QYCEA1ICHAUD ��',�,� ( YCE MICHAUD
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.l )ash MY COMMISSION # FF 083008
°a EXPIRES: April 25, 2018 f s EXPIRES: April 25, 2018
Boded Thru Notary
Puha Unda wnro
$4rded Notaiv
ru P
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED_
DATE
COMPLETED
Rev. 8/2/17