HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
CC> UNT`y
F L 0
BuildingPermitApplication
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: ) �,t'!1� lel . L
Legal Description: c� G "fir t �✓�
Property Tax ID #: 33� 7 7 7 °— 06� `� )y — / Lot No. lu_
Site Pian Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK: i
CONSTRUCTION INFORMATION:7�1
Additional work to be ertormed under this permit —check all that apply:
11HVAC
pp y
HVAC Gas Tank Gas Piping Shutters
11 Windows/Doors
[ Electric Plumbing OSprinklers Generator 1:1RoofRoof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ J _
S Ft. of First Floor: _
Utilities:nSewer Septic
Building Height:
OWNER/LESSEE: � CONTRACTOR: I I
Name I hC( C
Address: T1
City: state: R
Zip Code: 0_2 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company:
Address- (a/ n' P
City: N1�,,- CA State: rL
Zip Code: 2) Y 9 d 6 Fax:
Phone No. `1 2-_777-0Q/0
E -Mail: 1, I mt' o L-Whoo. co G?n
State or County License: t �� 0 � "f
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/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, 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 ocordinR your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner Signature of Contract License Holder
STATE OF FLORIDACC �STATE OF FLORIDA��
COUNTY OF �5 I� 1[ (� COUNTY OF
The fo�going instru ent was acknowledgeefore me The forgoing instrum nt was acknowledged. fore me
this k-2 ay of 11 + ° 20 � by this day of .' ^ H ZO y
Name of perscking statement Name of pers making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identificati
Produced Produced
5ignature`offa[ota Publi of Florida I rik Nemoga (s nit -6 of Notaryyli lorida) CI emoga
t Commission # GGIO1442
Commission No. - ien f GGNo.'*• (g; 4, 2021
'q May 4 2fl2i 2 Commission
. R Bonded thru Aaron Notary
' OFBonded thru Aaron Notary
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATIONFSEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEWEW REVIEW
DATE
RECEIVED
- -
COMPLETED
Rev. 8/2/17