HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Ndmber:i
' ° Building Permit Applicat-ion';
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:
PRt?POSED lNPROVEMENT LOCATIbN-
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Address: ^7L{o7_ Sia CA&A–e-A iorc ff EL 3Lf��
Legal Description: Lxv.•- tLg 7:70:,�= _,C,3Ue_' L,6r L_3 tLui – L'
Property Tax ID#: 13,-)( &Cal. auj( ann 2_ I, Lot No.
Site Plan Name: 1 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: 1
DEl'AILEb QE CRIPTION DF WORK
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INOA�ONSTN
itionwto a per orme under this permit-Check a ta_t
appy: :
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_Mechariical _Gas Tank _Gas Piping_ t _Shutter's "Windows/Doo'rs'
—Electric Plumbing Sprinklers -Generator i Roof Pitch
Total Sq. Ft-of Construction:" 1 45C'- [-0f6- Sq. Ft. of First Floor:
Cost of Construction: $ . Utilities: —Sewer —Septic I Building Height:
C+WNER/LESSEE, ;g
CONTRACTOR
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;Name Name
,Address: `Z`E.DL 54--1 Cke_,.6S 'Oce Company: O_As �
City: 'F Stater_ Address:3,2 `Z1.
Zip Code:?,u S.�I Fax: City: f--t, �cFi?_A 2,1;:–::: !F State:
Phone No. 17`7Z 332 5-�Z( Zip Code:3L{a,R-Z ax:
;E-Mail: Phone No L{"7
Fill in fee simple Title Holder on next page(if different E-Mail
.from the Owner listed above) State or County License
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If value of construction is 2500 or.more,a RECORDED Notice of Commencement is required.: !
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St1,PPI�EMENTAL CONSTRUCTION i.1EN LAW tN ORMATION
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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 y perty. A Notice of Commencement must be recorde sted on the jobsite
before the first i pection. If ou intend to obtain financing, consult with er or ney before
commencin rk or r rdig your Notice of Commencement.
Signa ure of Owner/Lessee/Contractor as Agent f I-9bSigna ure of Contractor/License Holder
STATE OF FLORIDA z a STATE OF FLORI
COUNTY OF COUNTY OF �/li�� ed V5
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The forgoing instrument was a knowledged before The f oing instrument was acknowledged be
this day of 20Y° by �w� this�day of lye4AL 201X b LU
(Name of person acknowledging � ;; ;'t (Name of person acknowledging)
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(Signature of Nry Pu�blic-State of Florida (Signature of Not Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.