HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE CCEPTED
Date: P rmit Number:
•
Building Permit App ication
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:
Legal Description: MffZ_& S 1, 110C_ SQL
Property Tax ID#: r>1&,L4 OC20 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Ad!ditiopgl work to Be Defformed under this permit—check all t=a p y:
_HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
0_Electric 0 Plumbing Sprinklers E]G nerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of irst Floor:
,/
Cost of Construction:$ n fit(4/ Utilities: _Sewer Septic Building Height:
OWNERAESSEE: CONT ACTOR:
Name QF,0AJi15 L f f,-,V 4JALAc Name: If. ' ik,04 1�
Address: Company:
City: iAii/, [ RI State:_ Address: W?D,J 4-IJ
Zip Code: �-,� - Fax: City: 5- Stater
Phone No._T !21'!q 17 Zip Cod .e2 Ogg,3 Fax:
E-Mail: Phone No. �. Ll02f?sLzr
Fill in fee simple Title Holder on next page(if different E-Mail: oi. c 0 !. ; 4r— ' I<.
from the Owner listed above) State or County License: 0At?y q P, i.2
If value of construction is$2500 or more,a RECORDED Notice of Commenc ment is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATI i N:
DESIGNER/ENGINEER: _Not Applicable MORTGA E 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 3ermit.
St.Lucie County makes no representation that is granting a permit will authori a 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 eed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree th t I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Luci County Amendments.
The following building permit applications are exempt from undergoing a full c ncurrency review:room additions,
laccessory structures,swimming pools,fences,walls,signs,screen rooms and a cessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commenc ment may result in your paying twice for
improvements to your property.A Notice of Commencement mu t be recorded and posted on the jobsite
,'before the first inspection. If you intend to obtain financing, cons It with lender or an attorney before
!commencin work or rec rdin our Notice of Commenceme
tv
Signa of O m r/Lessee/Contractor as Agent for Owner Signatuginstr
tor/License Holder
STATE OF FLORIDA l . STATEDA
COUNTY OF S COLIN A .
The forgoing instrument was acknowledged before me The forent wasacknowledged before me
thisday of ,20_ by this ,20A by
Name of person making statement \ ame of person making statement
Personally Known OR Produced Identification Personaill,Known OR Produced Identification- „ .
Type of Identification Type of Ic entification
Produced Produced
I
(Signat of Notary Public-State of FQlida) (Signa of Notary Public-State&f Florida)
Commission No. `w�"�""� ( ? 1. J,;; ,' '¢ W .HNA INGRAM
L� S,�iNA INGRAM Commiss on No. Sear
M44�
z< Not(y 7ub'lic-State of Florida
Notary Public State of Florida _•=My Comm.Expires Dec 20,2018 F^ - ( )° . My Comm.Expires Dec 20,201
,o n a� �.x rnmmission#FF 177249
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IN Assn.�' ,
REVIEWS FRONY""""' O R � ��ERVI QfI`� PLANS VEGETATIOI TS A, rU.KT, 1IVIANGR"0 E
COUNTER REVI`W REVIEW REVIEW REVIEW ' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17