HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: V 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: i�
Legal Description: rt) LqZ a Jrd/
Property Tax 11) #: ,.534 � }- M3 __QM I -Wo Lot No.
Site Plan Name: Block No.
Project Name: r
Setbacks Front Back: Right Side: Left Side:
DETAILED :DESCRIPTION OIC 1NOIkK.
C n 0u- 1 I ti (6n 1G�k'k
�1 k1)0 1 a V -f 0 - .5 -fin
CONSTRUCTION INFORMATION::;
Additional work toe pilffo-rmed under Tis permit— check all that appy:
QHVAC OGasTank s E]Gas Piping _ Shutters Windows/Doors
0Electric ❑ Plumbing Sprinklers 0 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ utilities: OSewerOSeptic Building Leight:
OWNER/LESSEE: CONTRACTOR.
Nam e -
Address: Company. t k,
City: NkA Pau, State -2_ Address: 'a 5 M010 -4 fNf
Zip Code:. Fa �rirL City: State.
Phone Nota-) Zip Code: 9Fax
E -Mail: 1 Phone NQ. 01 -11000
ry fit t1%
Fill in fee simple Title Holder on next page (if different E -Mail:
from the Owner listed above) State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
E
SU�`Pf�.�IIEN��� CONSTRi~1CTfON Lt�N €:A1N"�N�e7R1'VIATEQiV.
DESIGNIrR/ENG1Ni=1ilR.
Name:
� Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Not Applicable
Address.
City;
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
� Not Applicable
BONDING COMPANY:
Marne:
Not Applicable
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 permit.
St. Lucie Countymakes 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, l 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 leader or an attorney before
commencingwork or recordingour Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Folder
STATE OF FLORIDA
COUNTY of "'
STATE OF FtQ A
COUNTYOF � .
The f aing instrument s acknowledge before me
day
The forgoing instrument was acknowledge before me
RECEIVED
this of 2t3� by
this�� day af�i�L� 20�13y
i
i
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
i
{Signature of Notary
(Signature of Notary Pub1i
NAM. iilL1.
Commission N ' •'-�, CO ��N # GG 099038
- EXP ES;
��4
DONNA M. HILL
Commission N = � 510N # GG 099Q3t3
'
P pcil 30,2021
BcndeEi ThrerNBandedlT�:Ap
�Y Public ltndenvAiers
.- nl 3 0, 2021
°WY public UnQeneiters
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
Rev. 8/2/17
SU�`Pf�.�IIEN��� CONSTRi~1CTfON Lt�N €:A1N"�N�e7R1'VIATEQiV.
DESIGNIrR/ENG1Ni=1ilR.
Name:
� Not Applicable
MORTGAGE COMPANY:
Name:
Address:
Not Applicable
Address.
City;
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
� Not Applicable
BONDING COMPANY:
Marne:
Not Applicable
Address:
City:
City:
Zip: Phone-
Zip: Phone-
RECEIVED
(SATE
CQMPLETEI)