HomeMy WebLinkAboutBuilding Permit Application ALL L AePP CABLE INFO MUSTBF-COMPLETED FOR APPLICATION TO BE ACCEPTED
ib}l jbj�}-J` 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
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fOPC�}SgD�IMF"F�tVEMENT'LOATEON
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Address: t is . ,+
Legal Description:
Property Tax ID#: t n a c')v(_ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
;DETAl1 ED DESCRIRTIgN OE WOFtl4r
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31-D n.naof re, ra-0-11a
C(?NSi tCT10N INFORMATION ;,
itt na wor to (e�er Orme under this perms -c sec a V appy:
HVAC U Gas Tank Gas Piping _Shwtters Windows/Doors
11 Electric F]Plumbing Sprinklers �Generator Roof' Roof pitch
Total Sq.Ft of Construction: _ S Ft.of First Floor.
Cost of Construction:$_ � Utilities:oSewer RSeptic Building Height:
L�11tilNERjt':E�5E��`.
Name i Name:
Address: Compan
City. State::., Addr ss.
Zip Cod ' Fax: Cit State
Phone No. Zip Code' Fax:
E-Mail: Phone No. +
Fill in fee simple Title Molder on next page (If different E-M'a'I:
from the Owner listed above} State ounty Licen 6 6
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required. j
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SUPR,LEIyIENTAL�CON5TRUClION LIEN LAW;INORMAzTID ! ,�F,?;
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 ApplicableV
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 thepermit 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 Fwill,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 noh-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 tA obtain financing, consult with lender or an attorney before
commencing work-o'r recor d i ng yoVrwlof Commencement.
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signature of Owner/les /C1_'
ractor as Agent for Owner Signature of Contralder
STATE OF FLORIDA n q- - STATE OF FLORI 'A�O
COUNTY OF 1 V L I�.1 COUNTY OF_
The goin instru t s cknowled efore me The fr oing instru n a nowledg d efore me
this"day of 20 by this !t da of ' , . Y
IP � �
Name of p -rV m king statement of so making st ternent
Personally Known �/ OR Produced Identification Personally.Known OR Produced Identification
Type of Identification Type of Identification
ff
Produced Produced
t noo ua�xl - &M-_ __
(Signature of Notary Pu ' -State of Florida} (Signature o :Notary PubU-St a of Florida)
Commission N �Llq Seal ommission NP (Seal)
CRYSTAL MARIE CRL°'I.NL:f
MY COMMISSION 9 FF99321 A.--P:'s CRYSTAI.MARIF. CROZAD
:?�oF��
EXPIRES June 25,2020 MY COM ISSION#FF9932 7
REVIEWS FRO Sae o QNINGFro�ida o 64W.1:5 1R LAMS VEGETATIO %+ TUR€WpIR affN�AI(j�0
COU W REVIEW REVIEW (407)41. Hold:Noijlrg rOgd.:om
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17