HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date:, 1 ` 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�pe
PROPOSED IMPROVEMENT LOCATION:
Address: (01 0 CA- )�'e cam,, V
Legal Description: �a--I L) 3 ��.� k- A Q 3 _? CC Com- ;-_7j . 3
Property Tax ID #: )) _2� LN�[ -�) - �U G ��)� U Lot No. tj
Site Plan Name: N_) U`�� CI Block No. rJ 11
Project Name: 0
Setbacks Front Back: Right Side: Left Side: _
DETAILED DESCRIPTION OF WORK:
� v
A ,
LCONSTRUCTION INFORMATION: i
r orme un er tGas Tank �Gas Pimis peritc ec a app y.
Additional worK toff
HVAC Shutters ❑ Windows/Doors
❑_ Piping
Electric ❑ Plumbing Sprinklers Generator ® Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: A/ M
Cost of Construction: $ S,-4()0, C (' ; _ Utilities: 0 Sewer Septic Building Height: A.' 1,PY
OWNERAESSEE: i CONTRACTOR:
Name Lm A( Li j tAn q i A_ I_ �1 ��
Name: C'C_ 'i 1 Y-'
Address:
Com pany�c�ku
Address: -A`�_�C) �� c k C G. <'�
City: �� ,z C Stater•
Zip Code:--'-,Lt`-� Fax: w�
Phone No. 1 V1 �. - 33� - _1',_1
City. - —5�_ �1�.e Stater -
Zip Cod U)S _Fax: _
E-Mail:
Phone No.
rI
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: 1 ov \, j s-,8-t-ose r'-ll 11
State or County License: LC t 13 to to � Q
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Ex r a EF S a t [7y e '� r3 E
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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: ).j 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_LeLQrding your Notice of Commencement.
Rev. 8/2/17
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Signature of Owner/ Lessee/Contractor as Agent for Owner Signa re of Contractor/Livens Iden
STATE OF FLORID +.��� STATE OF FLORI A
COUNTY OF J 1.t, COUNTY OF LL) � � -L
The for oing instru nt was acknowledged before me The for oing instrur��nt was acknowledged ,before me
this/ day of 20��by this � day of �p� _'20
� by
�(A I tlJ l �{.ls ���'/ j�_S� v�.� �:_..l ✓ �'i,.� 1 �r � �l� � l5 T e�n.�(r�.
Name of pers n making statement Name of person making statement
Personally Known- _�__ OR Produced Identification Personally Known �_ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signa ure of Notary Public- Sat,of,F ida) (Sign ure of Notary Public- State lorida )
r ry� I�piaC ronT ,�,�r ^u,� AIAFtK
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Commissi�' ComAilebn#GG Seal) Commiss� ' (Seal)
N � F.xpiat September 19, 2021 SO- o� Expires September '19, 202111
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