HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED rr�
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: �3� /�' CIiJ�, ��t� /� ►�G e, S/
Legal Description: /tile Cc ELO -U Ril Tu'V- Lo f 3 o -
C/45 7 - �2 q-3,7—)
Property Tax ID #:
Site Plan Name:
Project Name: V_
Setbacks Front
�r-000 y Lot No. aJs
K
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Back: Right Side: Left Side:
I. DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit - check all that appy:
HVAC Gas Tank Gas Piping _ .—Shutters Q Windows/Doors
Electric ❑ Plumbing FISprinklers D Generator 11 Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 1-:5 '�? f
OWNER/LESSEE:
Name
Address: J` ✓
City: �'�{/'G `e— State:
Zip Code: c3y9SL_ Fax
Phone No. 1/09- VV
E -Mail: YYlMl!i -;?9/P
SFt. of First Floor: _
Utilities: Sewer F-] Septic
Fill in fee simple Titl6 Holder on rltxt page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: M l-rll a y%H IQw"�? /
Company: P -eLe
Address 06,
City: Fiff/ State: F2=
Zip Code: Fax: U
Phone No. 2 • 1-58'1
E -Mail: d4 0, Y1ri CA 'n C
State or County License: ___2 443f:Z
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 your Notice of Commencement.
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Signature rOwner/ Lessee7Contractor as Agent for Owner
Signature of ntractor/License Ho der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF '3� LUC,i!
COUNTY OF St
et) -e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this L day of rv- Aa—,A,
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this qday of�,G',�
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Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known
OR Produced Identification ;;14—
Type of Identification
Type of Identification
Produced L✓
Produced�(v
(ignature of Notary Pubf
-'State of Florida)
(Signature of Notary Public ate of Florid
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Commission No.
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REVIEWS
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PLANS
VEGETATION
SEA TURTLE
COUNTER
REVIEW �l
REVIEW
REVIEW
REVIEW pR
DATE
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RECEIVED
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DATE
COMPLETED
Rev. 8/2/17