HomeMy WebLinkAboutBuilding Permit ApplicationSUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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, wails, 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 your Notice of Commencement.
Rev. 8/2/17
Signature o wner/ Lessee/Contractor as Agent for Owner
Signature Holder
STATE OF FLORIDA
�Ctractor/License
STATE RIDA
COUNTY OF ue
COUNTY OF , M61
The forgoing instrum was acknowledged efore me
this _day of 20 10 by
The forgoing instrum wasacknowledge efore me
this .0 da 20_L<S by
Name of person,king statement
Name of persoking statement
Personally Known VZOR Produced Identification
Personally Known OR Pr Identification
Type of Identification
Type of Identific4iw�
Produced,," ,-'
Produced
f
�.
(Signature of Notary-FlCr'"IQA # GGIO1442 w 111gillwya
Commission No. PRO& MY 4, 2021
(Signature of Notary �lor�isslon i GGIO1442
Commission No. %Y 4, 2021
��
Bonded thru Abell
B N AarOn Notary
Notary
mb
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Carle Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1558 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: -1'-1)32 'P, -n -e _ ,-4 f i Q
Legal Description:
Property Tax ID #: _c "; �� �% 7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
4'\A UV\' 'OAZ ic7�� tt�1 Vv1u�C 'i
CONSTRUCTION INFORMATION:
Additional bepe Ye
Orme un ert is permit_-_ ck a F1 appy:
HVAC 1 Gas Tank -Gas Piping Shutters a Windows/Doors
_l
11 Electric ® Plumbing O Sprinklers 1:1 Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer E]Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name j%' dzee
Name:
Address: ''-k
Company: ;�f U } .1'7,1 C--'
City: VD 0 L.t..t �-a, e__ State: —
Address:
Zip Code: 31 ' J Fax:
City: � � C� State: ��-
Phone No. `]� 7 - j " 7 YO
Zip Code: 1 j Fax.
E -Mail:
Phone No.
` -7 77- 00/0Fill
in fee simple Title Holder on next page ( if different
ii
E -Mail: Ct4 we 1 i (\A CP
State or County License: C -FC ti� N o_? Y
from the Owner listed above)
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.