HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFQ MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q l�
Date:�a� �� Permit Number:
Building Permit Application -RECEIVED
Planning and Development Services J J
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 c ty permitting
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Res cf.11
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: _-�11+0 D" o n O�G
Legal Description: 1�u n n Kr S(-C�4-2z /D f g 46"! D L6 1'3 �� '2�'20L ��3-2�6)
Property Tax ID#: 11>4f 000y- -000 -9 Lot No. 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
[CONSTRUCTION INFORMATION:
Addi-ti-o-n-aFw--o-rVt-o-be--iD)-e-rfo-r-m-ed-u-n-de—r this permit-check all appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ 500 _ o° Utilities: ❑Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Ce.l\ c,,,\ Name: _T;L-A , aLci
Address:(,)9; S3 Company: f=&5 Elpc�L( L ��nL
City: c5q-� 5>y State:_16�_ Address: ('SOI oleanA o Z PrJ e-
Zip Code: ?,4-"-'J'!�22 Fax: City:(" Pl �_r(ne_ State: f;L-
Phone No. Zip Code:�qel t 1— Fax: 7 72 40- 1 3 591
E-Mail: Phone No. 772- 4 19 (,-
Fill in fee simple Title Holder on next page( if different E-Mail: 5 ?2 - 0,c'I - Com
from the Owner listed above) State or County License: EC 000 15
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 or recording our Notice of Commencement.
Sign atu o Owner/Lessee/Contra or ent for Owner Signature of Contractor/License Hold
STATE OF FLOR�pA - OR
COUNTY OF �-} COUNTYOF - LUd
The g instru ent was acknowledged before me The for ing instrur�nt was acknowledge efore me
thi;V day of f-•L 20� by thisday of tN 20_(6 by
LKr�
Name of pers9p making statement Name of perso making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Pr duced Produced
f
(Si'gf nature o Notary Public-Sta i re ofotary Public-State
, v:ay ;•., STACEY GARCI .'.','i., STACEY GAR(:IA
Commission IN �' : . F gaQY COMMISSION#GG 8.5Mm sion N n�LI ( *Y COMMISSION# G 840
EXPIRES:May 16 2 21 .„ ,;? EXPIRES:May 16 2 1
• Bonded Thru Notary Public
;o. Bonded Thru Notary Public U I_
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17