HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application FEB 2 7 2018
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
P:RQPOS>=D iMAROUEMENT ROGATION
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Address: Lbt�o olr'a�leLaC Ai 12r 2
Legal Des ription: lO e y1 1411 r e O(e/-- In
—1/1 M,h 12 1 tc�p� i A_/d
Property Tax ID#:
4-4,57/
l6 0 006 Lot No. 2 13
site Plan Name: Block No.
Project Name:
Setbacks Front_ /0 Back: Right Side: Left Side:
®ETAILED DESCRIPTION OF
a CAJ rev,e,% 1 3J- 5Vrv&e r-
cnd' d
77777771
. 1�STRUCTION I(�FORMATIGO(V.
Additional work toe e orme under this permit-c ec a at apply:
EIHVAC E]Gas Tank E]Gas Piping Shutters Windows/Doors
Electric ❑Plumbing aSprinklers 1:1 Generator ®Roof Roof pitch
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Total Sq. Ft of Construction:: S . Ft.of First Floor:
Cost of Construction_$ L Utilities: Sewer OSeptic Building Height:
01NIERf LESSEE:..,
_CONTRACTOR
Name �"d' /7 Name
Address: t'J �1 Company: c - <' k T �C
City: I® 1,T State: Address: (ryACt.U P,cz,
Ct
Zip Code: Fax: City: f\ C-' f t' CC c,C'_�� State:r—
Phone No. 601 :3•"'Jq 6 Zip Code: :�i0 9 5 -t Fax:-T7 QST- I a'5 5
E-Mail: Phone No. a-0 I -q c' Lf S
Fill in fee simple Title Holder on next page(if different E-Mail: ITA t lA ' ( C> I +' /- G: I o ry
from the Owner listed above) State or County License: toqi
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if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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.
S(gnaturkofb�caner/Less /Contra or as Agent for Owner 9(gn a�fu rg bftoj6tra�WU ce older
STATE OF FLORID . STATE OF FLORI
COUNTY OF 2(t-66Z,- COUNTY OF
f St 12
The ing in ru.Wnt as acknowledg before ne
The fmoing instr it was acknowledge efore 21
0�! 2( by
thisxdayof _!Z�-
this-W day of Mb b
5 2 -5
A�Tpee_ - W�.
Name of pe,�qn making statdment Name of perso aking statempAt t3-�: 9
Personally Known OR Produced Identificat n Personally Known �OR Produced Identificat &�w
OE:
Type of Identification Type of Identification
Produced
Produced
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L,A*-;_F
(Signature of Florida) Public-State of Florida)
ignatur of tryPublic-State orid (Signature of Not
Commission No. (Seat) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17