HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 4 �
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Building Permit Application
gIOZ S O ONPlanning and Development Services
Building and Code Regulation Division am 111L 1011
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial139wig3korn—M
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROwROSED IMPjROVEMENT LOCATION' y ' '
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Address: 7 a 2 ✓ 6rePk bro ve i L
Legal Description: V ee Lot- J
Property Tax ID#: 3322 -601 -001& -000 -S' Lot No. �S
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTtON'0 WORK N k -
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CONSTRUCTION INFORMATIOfV' n
Addi wor to e e Orme under tis permit—check
a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing U Sprinklers Generator F Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First•Floor:
Cost of Construction:$ a900. 00 UtilitiesSewer❑Septic Building Height:
OWLESSEE r s { CONTRACTOR _
Name�F,/;se FArce / Name: %i Laoe2
Address: 7 ,rO es6'J e. r: Company:
City: 'S4• State: Address: I S 7 .S W /�► I (i Ave.
Zip Code: &YQ9� Fax: pity:i'e_ rr L%&e!P State:
Phone No. �77�> ag�'�S3�o Zioa Code: -3 YPS3 Fax:
E-Mail: Phone jlo. 77 70
Fill in fee simple Title Holder on next.page(if different E-Mail'' DrI0
from the Owner listed above) State or County License: ?
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW IN'FORIVIATION
_.. ENGINEER: _ Not Applicable _. ... .-.: • r>� .._, -: , WWII
NER ,w.. . .-
/ `MORTGAGE COMPANY: pplicable
Name: Name:
Address: Address:
City: te: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Ap p lir.A a BOND IN PANY: _Not Applicable
Name: Name:
Address: Address:
City City:
Zip: one: Zip: Phone:
O R/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.
Signa re of Owner/Lessee/Contractor as Agent for Owner Signatofe of Contractor/License Holder
STATE OF FLOR34
KM STATE OF FLORID
COUNTY OF •., COUNTY OF
The f ing instru ent was acknowledgeforei;�'A The for oing instrument was acknowledge '
this day of 20by """*•••• this_X day of 20
Xo�'v x�
Name of perso aking statement �,�—,`� Name of person making stateme z mk
Personally Known OR Produced Identificatio �'s Personally Known OR Produced I oti
Type of Identification Q�T ype of Identification I z=
Produced a roduced �ffl':9
m o_A m
(Signature of Nota ublic-State of Florida) (Signature of NotK Public-State of Fldri a
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