HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' �• ��' Permit Number:
RECEIVEDtb]
Building Permit Applicatic in
Planning and Development Services APR —9 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 kR
g Dep men t
Phone:(772)462-1553 Fax:(772)462-1578 Commercial EtdeLrUi@ 4
nt FFL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description: N2_GiinJ ,[[SE (')iJoo in i SoLi
Property Tax ID#: �'�l� 513- 004 a. UUy 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
12rPLA C,, SAMA Clio- 9AM45 a-r�,� f��<v ��-CC-�
I w/S 11-tJ 14C-Al-
CONSTRUCTION
4`-ArCONSTRUCTION INFORMATION:
mitin
wor to e e orme un ert ispermit-c ec a appy:
Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers 1:1 Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �� `� Utilities"nSewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name fAV id AWES Name: (ZICIA&A -1 , Vol-KA 9-1-
Address:
1-Address: ' ,Q ' 1`3ux f-191 0144a01 Company: C-PLD f2c--!` GJD`'1 A/C. )A)<-
City:
NCCity: 1q V 49L,y (`I A t/UF- state:011,:' Address: C 3 3 .N I 14oKI ZoA) Z,4)
Zip Code: 0, 4402 Li Fax: City: 1 J P�� -S-1- cue_l�_ State:—E-L
Phone No. 20'r) OIL)Ll 2_ l 2 Z Zip Code: y 9E>,J Fax: /
E-Mail: Phone No. q'IX G06
Fill in fee simple Title Holder on next page(if different E-Mail: a V0 Ck_A&_ Zv o3 M(1)Z
from the Owner listed above) State or County License: v Cts/-1
J!;"
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 No menceme
Signat of caner/L ssee/Co ractor as Agent rr caner Signature of Contractor/L,t' nse Holder
STATE OF FLORIDA _ ��o STATE OF FLORIDA _ TH
COUNTY OF 2 m ig COUNTY OF 2 RIO
ion 6
The forgoing instrument was acknowledged befor r The for oing instrument was acknowledge e T
this day of 20 by �T this day ofd��_20/ b �T m�
CA<
N
Name of person making statement Name of person making statement
Personally Known OR Produced Identifica ion Personally Known OR Produced Identi
Type of Id is tion Type of Identifi n
Produced Produced r e ,
(Signature of otary Public-State of Florida) (Signature of9ltary Public-State of Florida}
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
Rev.8/2/17