HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f 'S Permit Number:
•
Building Permit Application
Planning and Development Services
Building and Code Regulotion 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 _�_k
PROPOSED IMPROVEMENT LOCATION:
Address: (n O�-I � L L � �.� rr pp. 1� e.0 Com�� _ j`1cl's i
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Legal Description: Cn t� �a�L Q c� 1 +— _ 7••'' ) L ( C-1
Property Tax ID #: 1 ebb - III - Lot No.tJJA_
Site Plan Name: //�LA C � Block No. ,;J f
Q -A
Project Name: 1 OG�IlViY1
Setbacks Front_ Back: Right Side: _ Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be ertormed under this permit�c check appy:
7HVAC Gas Tank F]Gas Piping _ Shutters ❑ Windows/Doors
1-1 Electric ❑ Plumbing ❑ Sprinklers Generator ® Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ (n t'-� c
r 4 L (,
S.
Utilities:
Ft.
of First Floor:
Sewer []Septic
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Address: (o -i uti C t e C)
Building Height:
OWNER%LESSEE:
CONTRACTOR:
Name .�h r� �, ��c:�1 �.� �L
Name: L-_'� i
Address: (o -i uti C t e C)
Company: , ;_r
Address:
City ��C )r � . �.�.1 �Y�e
Zip Code: 3y �1 S
Phone No. a--
Ll V_
o, ST =
State
Fax:
n
O
City: State:rl -
Zip Code:`3Lj Cj S Fax: t'J ) iQ
Phone No. Cl4Scl - L4 _�30
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: c lsvtnr
State or County License:
(`.(° , ) ,� 6 6-a' G
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: � Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: k, Not Applicable
BONDING COMPANY:)LNot 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.
7
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Sign Jure of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA-,
STATE OF FLORID4,
COUNTY OF J/, ca C tic.
COUNTY OF `,��, L,C,'C C,C(
The for oing instru ent was acknowledged fore me
The forgoing instrumfe� t was acknowledged fore me
this day of 20 y
this � day of 14,4;1 20�y
Name of person 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
C _
(Signat re of Notary Public- State o orida)
(Signa►uure of Not Publ_ i.c=St f FI ida )
Commis '. 'I"" �� t 9! (Seal)
cammissro #
F_xpkes Sep
Cis*�• � �I#�N�Nr'd� (Seal)
Expires Sep
'�oF Bolded na &WYM W" sa'�
IF ie 7jF BMW nw evd�r+or.ns«tiro»
F�o�O
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17