HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3_ - / Permit Number:
Building Permit Application MAR -8 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:
PROPOS.EQ INPROUfME'NT:LOCATIC}N
Address: 73 e 0
Legal Description:
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Property Tax ID#: 3� 3�- 60/ - O®oO - C7oy/ Lot No.
Site Plan Name: Block No.
Project Name: AWmr`,-o,l Uv h r�'J' ,-51 s oG ria fi lox-,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION aF WORK
r
'� CO�N5TRUCTIONFIN,FORIVfATION
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
VElectric _Plumbing _Sprinklers ° ';;Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of Furst Floor:
Cost of Construction: $ Utilities: —Sewer —Septic Building Height:
C}WNER%LESS"EE CQNTRACTOR.
1
Name /Toll ��'ro( � tirrS /��SoGr'of�'ot, Name:
Address: e 0 S xz, Company: /C /-lc c}.-
City: State:'/'• Address: P D• a ar R cv Y
Zip Code:_3,-f9,5' > Fax: City: State: /'/
Phone No. 7 7.,? - -2.,2 9 -3 3 oLS Zip Code:3N 9 9 SS Fax:
E-Mail: Phone No 772 - 2 8 S- y % a 7
Fill in fee simple Title Holder on next page(if different E-Mail J6,9,-, .-n /r 4—Ar :G 00 ,STT. /lie T
from the Owner listed above) State or County License .4 G /30 0-2 7 ?J_
JEvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1PPLEMENTAL CQ.N5T�2UCT[QN LIEN LAIN 1NF�RMATI�N
� pp MORTGAGE COMPANY:, _
DESIGNER ENGINEER: Not Applicable _ 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.
Signature of Owner/Lessee/Contractor as Agent f Signature of Contractor/License Holder
STATE OF FLORI!Zj6 fo es STATE OF FLORIDA - _ ......
*. ,
COUNTY OF COUNTY OF
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The f oing instr men was acknowledg before XC,a The forgoing instrument was acknowledge efo �e
this da of 20 -b 2 MK 9 this da of 20 b a R,
o. /-y� y�
Y Y Z�� Y /fly. Y a x�c
iZS2 m 2 Sim X
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(Name of person acknowledging) 8 (Name of person acknowledging) c az
(Signature of N ry Public-State of Flor da) (Signature of No Public-State of Florida)
Personally Known OR Produced Identification / Personally Kn OR Produced Identification/
Type of Identificati Type of Identifica ' n
Produced Produced �C
Commission No. (Seal) Commission No. . (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.