HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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: 33ia, NW Pet- IrDe3f-f- Rd
Legal Description: VVICIE! NCtf_e'V_S S 0 L -0't a D�
Property Tax ID 003 CXX) Lot No. -a 37S
Site Plan Name: Block No.
Project Name: oubct Re`',icierye,
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
) iA a -c t w n tc,_ I SCJi i cr
'-Rerno,ve- and �-ep�ic/,ce_ (D
I rn pcue, f vNl' n ci o " s
CONSTRUCTION INFORMATION:
Additional work tobe nerformed under this permit- check all that apply:
F]HVAC 0 Gas Tank Gas Piping Shutters Windows/Doors
F]Electric F]Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt of First Floor:
Cost of Construction:$ 4 1 C—CC - C 0 Utilities: Sewer Fleptic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name P111,W) 6(:ba' 14 COVIVI V VC1
Name: 'Wivid is"Piotne,
Address: 53iA NW pe(Imettr RCj
Company:':113e (Nuss
Proi;essl'cnods
City: State: FL
Zip Code: .34PjcjD Fax:
Phone No.
Address: 3611(", Ge
city: 'Sh"01 V-6
Zip Code: -7�'qqjj
INXIe 9V1J'V
State: FL
-Fax: '17a-3ZK, -04W
E -Mail: prigfif)nctui nuhn rein -mad , roo
Fill in fee simple p
e' 'AtIeHoldVronnex%t_ page different
Phone No.
E -Mail: 12r -r -0 ().V,-,`PY0, S
_Mlt
State or County License:
from the Owner listed above)
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
commencine work or recordinp, vour Notice of Commencement.
Owner/ Lessee/Contractor as Agent for Owner I Signaturedf/Contractor/License Holder
F FL
COUNTYOFORIDA a, + ICOUNTYO
STATEOFORIDA v'
The forgoing instrument was acknowledged before me
this q day of NIC4 , 20 by
U I d?- L it
Name of person ing statement
Personally Known OR Produced Identification
Type of Identification
Produced
l
(Signature of No ry Public- State of Florida )
Commission No. _ t Y,�""""��, Ei`1~&t WIDMAN
Notary Public • State of Florida
• Cowdssim 0 FF 929255
REVIEWS F;16=
COUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. $/2/17
The forgoing instrument was acknowledged before me
this 9 day of MQki 20_1b by
Name of perso aking statement
Personally Known V OR Produced Identification
Type of Identification
Produced
(Signature of Notarpblic- State of Florida )
Commission No.
PLANS I VEGETAM
REVIEW REVIEW
KWN flDMAN
Notary Public • State of Florida
COMMISSlon • FF 929255
REVIEW I REVIEW