HomeMy WebLinkAboutBuilding Permit Application (2) ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I n ^
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: f G
Legal Description: .w _ Z.v G� G v 7-
Property
-Property Tax ID#: z�}2/-�D �VOID�� c'900 - Lot No.
Site Plan Name: /_21— .� / Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
.CONSTRUCTION INFORMATION:
Additional work to bertormed under this permit-check a appy:
HVAC L_J Gas Tank E]Gas Piping Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: 2--3 / S . Ft.of First Floor:
Cost of Construction:$ Zo o D Utilities:,n Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 7 e iwe_ Name: y `I/
Address: /� 9/ S 7-4 C�11�— kjeg t- �!�� Company/, V
City: L State: )X�I Address:�Z /Q/�.5
Zip Code: 3g9Z1 Fax: City: �7/ .`���� State: rte/
PhoneNo. ��U�" �Z 7�� Zip Code: 3,fCFe2 Fax:
E-Mail: 1 P �� �, ov Phone No. 7Z2- -
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: G 6G 0 3 �f0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW]NFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: ,y0 dte--- 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 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 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
beforeA.hefirst inspection. If you intend to obtain financing, consult with lender or an attorney before
menciAg wor or recording our Notice of Commencement.
I 44XJ114" �'7_> Qo�4AC
Sig ure of 0 n essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA- STATE OF FLORIDA - ll "Cu,TY OF �� CLQ , COUNTY OF�14j h--l�
The forgoing instrument was acknowledged before me The for oing instru ent was acknowledged before me
this�day of CM ,26J-6bythis day of 26 by
0o'n-
Name of pso making statement Name of person aking statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
JAMIE U �s
Sin a of Nota Public-St �`' CONN R(Sign e of Nota Public-St a of r a
g Notary ° �Notary Public-State o Fonda Notary �` JAMIE O'CONN�R
Commission FF 9 7 = Notary Public-$tate o F rida
Commission No. -� .halt & Sion No. J1 al�ommission#FF 9 7 3
•,��'�oFn:,` Oly Comm.Expires Jan 3,2020 �,,� ;� My Comm..Expires Jan 3, 020
Bonded through National N ary Assn.
"'°� � Bonded through National No ar Assn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17