HomeMy WebLinkAboutBuilding Permit Application 'i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: •
Building Permit Application
Planning and Development Services
Building,and Code Regulation Division
2306 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 IIUIPROVEMEN°T LOCATION
f
a� a-
_Address:
Legal Description:
;Property Tax ID#: ��� - 1 2- � - OC � O Lot No.
Site Plan Name: Block No.
.'Project Name:
Setbacks Front Back: Right Side: Left Side:
D.ETAILE'D DES:CRIpTION QF W}ORK� yy r A a rp `E
4�acq_ am ne C�-
CQ#NSTIZ,UCTION INFORMATIONr#� }
L a
� fig,
itiona wor to. a er Orme under this permit-check a a ply:
HVAC Ei Gas Tank 0Gas Piping _S utters ❑Windows/Doors
,Electric 0 Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ C:) � Utilities:nSewer.[]Septic Building Height:
O,V1lNER/LESSPEEyr ,. `CONTA,
,. _
Name- end Name:
Address: ( 4 Compan L
City: Stat(P, Address: l .�_>
Zip Code: Fax: City: fes/ State.
Phone No. - C� Zip Code:�J`C�aZ `` Fax:��2-YU1
E-Mail: Phone No.
Fill in fee simple Title Holder on next page if different E-Mail: CkV yy S ab -CRwvI .
from the Owner listed above) State or ounty License: (` �3U O 1 U43
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
$;UFPCEMEN CAL CONSTRUCTION LIEN LAW INFORIVIAT ON
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 obtai 1 a permit to do the work and installation as indicated.
I certify thatno work or installation has commenced prior to the issuance of a permit.
St. Lucie Countyy makes no representation that is granting a permit will authori a the permit holder to build the subject structure
which is in contlict with any applicable Home Owners Association rules,bylaw or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review you 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
cornmencin work or recordingour Notice of Commencement.
Signa re wrier Lesse n r c or as Agent for Owner Sign t e of Con or icen older
STATE OF ORIDA STATE FLORIDA
COUNTY OF Sac s. COUNTY OF
The fprr�oing instru nt was acknowledged efore me The forgoing instru ent was acknowledg?4 before me
this .` day of 20by this ay of 20_ by
%.,V--Q V4
n _
��e
Name of person making statement N e of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
-Type of Identification Type of Id ntification
Produced . Produced
i
dnatu of Notary Public-State o rida) (Signa t o Notary Public-State of FlNdY4e)
Commission',No. ��"�� �, I_(Sepl)INAINGRAM CommissionNo �a >ayF� LASIIAI�SIRAM
Notary Public 54a4e of Florida { °»�1« notary public-S4a a of Florida
n My Comm.Expires Dec 20,2018 (= 1 MY Comm.Expires Dec 20,2018
Commission k`FF 177249
o ° ��� t °}"� Bonded through Platioi al Notzr Assn.
rgim�d tit (Ou9i1 �afinrvl hln ar�i qcG i' r�n" 9 y
REVIEWS FRONT ,; �Z�S ��I SUPERVISb�i PLANS VEGETATIONS SEA TURTLE'-- 'MANGR'OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev:8/2/17