HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:p� -lel- < O ?- 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
Address
Legal Description:
/r:�?_ /l
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back
DETAILED DESCRIPTION OF WORK:
�_ 204"(I<—I' 4
Right Side:
Left Side:
'6%L7 7J
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be erformed under this permit— check all apply:
HVAC Gas Tank OGas Piping _ Shutters Windows/Doors
Electric LJ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction• _ S. Ft. of First Floor:
Cost of Construction. $ /� Utilities.Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Address: /�! a !elr"
Name: C'cs_;C Q0A) to
Company�a;g 1rttJ _i'L4 lZ /
City:A)'S-f State
Zip Code: G Fax:
Phone No. 22 0 6" 7.5- 5 fs _7
E -Mail:
Address:,-*', C3 C25' .P//
City: I, Le-, Stater
Zip Code: , 1/2 � Fax:
Phone No. 7i�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: C w �Vl
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: V Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name,
BONDING COMPANY: of Applicable
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 Horne 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
commencigg work or recording your Notice of Commencement.
Rev. $/2/17
SignaZie of Owner/ Lessee/CAntractor as Agent for Owner
Signature of Contractor Lice Holder
STATE OF FLORIDASTATE
!"�
OF FLORIDA
COUNTY OF %
COUNTY OF
The forgoinginstrumeyt as acknowledged efore me
this day %�� 20 by
The forgoing instrument was acknowledgeff� before me
this day of 2%'by
of
Name of person making statement /
Name of person making statement
Personally Known OR Produced Identification i(l&;,-
Personally Known OR Produced Identification L�
Type of Identification
Type of Identification
^rou :ccs
ored" .ed
f
Alan T, Ha
Pub10
/ Notary Public
(Signature of Notary P bli e of Flori aoiFbnda
(Signature of No ry Public- of Florida$Moof Florida
%W Comma on Expires 07110/1021
My Commission Expires 07/1612021
Commission No. �No. CG124770
Commission No. Corm9mVa.GG124770
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. $/2/17