HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ''II� Q
Date:
Permit Number:
906- O't'q I
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)46271578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click rrow at the end of line
P,ROP.OSED,IM`PROVEMENT,LOCATIO`N
;
Address rl nGZ F4151,
Legal Description:
Property Tax;ID#: - O/ ' 00 - o0o-5 LotNo.L.d/ 57
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: eftSide:
777777-1
DETAILED DESCRIP T101910,15-WOR
PC_Roo r Shy nyP- to Shy nJ
_ekMlco S,;Aglf JCA= 15- la 15.to
Q0•t,k S�;�k NoJ4' F� 1'101' ��
Under IgYMtn4
CO'NSTRUCTION.INFORIVI'ATION
., ,. ..
'Additionalwork to be nertormed under tis permit-c cK all ap y:
HVAC Gas Tank ❑Gas Piping _Sh tters Q Windows/Doors
ElElectric 0 Plumbing ❑Sprinklers Generator 12 Roof MZ Roof pitch
Total Sq. Ft of Construction: �1 Sq. Ft.of First Floor:T<d
Cost of Construction:$ 2�yo� Utilities:Sewer®Septic Building Height:
,OWNER/LESSEE t4 CO.NTR CTOR•
Name l/,A6611-A Goy�l,',Al Name: i'
Address-&w3 IN Company:wL/,WC/e__40 �cd•,i�,�/AC
city: State:State: Address: w
Zip Code: 3y�f, Fax: City: G! Stater
Phone No._nDQ S7Q 1 Zip Code: 24GL Fax:
E-Mail: G yy2 Q Phone No 77� 3®d- -2" l
Fill in fee simple Title Holder on nd'4 page(if different E-Mail: ,1-COIF
from the Owner listed above) State or County License: "7
If value of construction is$2500 or more,a RECORDED Notice of Commence ent is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INEORMATI N
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11' ..x�7df. s .�; �.a £,;,
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 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 rand covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your eed 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 Commence ment 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 inspectlorJ44f you intend to obtain financing,conSL It with len er or an attorney before
commencin work or rdin our Notice of Commencement.
Sign ure of Owner/Lesse or as Agent for Owner ignature o Contractor/Lice der
STATE OF FLORIDA � " � � STATE O FLORID
COUNTY OF_�. COUNTY OF !�kyj�
Thefgtgoing instrum t was acknowledged before me The forgoin instru nt was acknowledged before me
this day of 20�by this d y of 20 by
Name of person making statement N me of person making statement
Personally Known OR Produced Identification`' Personally nown OR Produced Identification
Type of Identification Type of Ide itification
Produced ;(sigaturl
\I
(Signatu No ry Public-State of Flori ) f Notary Public-State of F ida)
91
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17