HomeMy WebLinkAboutBuilding Permit Application i 4
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TOB ACCEPTED,
Date: ,ZZji� Permit Number:
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Building Permit Ap lication �
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Planning and Development Services,'i
Building and Code Regulation Division �eRl7ltti
2300 Virginia Avenue,Fort Pierce FL 34982 i St
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Phone: (772)462-1553 Pax: (77 )462-1578 Commercial Residential /
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PERMIT APPLICATION FOR:' To Select from dropbox, click arrow at the end of line
PROPOSEb- PROUEM 9T,1�LOCATION:
Address: 33 05 W ea h C-E
Legal Description: -,7 , 3S40 if%. 1 2J b.P Z tz-
'
a C-P IP NVAN. , 144 - Le_ss kA is FT
Property Tax ID#: Lot'No.
Site Plan Name: LJ 9. fw S Block No.
Project Name: o1„v�s
Setbacks Front Back: Right Side: Left Side:
DETAILED"DESCRIPTIONOF WORK.°
�2Qt` �ws1e� lv` c�'Lt 352 ,x' St" 1�
CONSTRUCTION INFORMATION
Additional work to be nerformed under this permit-check all apply:
HVAC Gas Tank ❑Gas Piping _Shutters E]Windows/Doors
Electric ❑Plumbing Sprinklers ElGenerator MR`oof Roof pitch
Total Sq. Ft of Construction: S . Ft. o First Floor:
od
Cost of Construction:$ eZ V LJ Utilities: _S wer O Septic Building Height:
ODUNER/LESSEE.: 'CONT ACTOR: `
Name � 5 Name: csl,V_C
Address:�7,, Lv— Compa Y_7"'o6_v„(Z.
City: 27, A'e.cere�, Statel Addres : _74a(
Zip Code: 3ggT7 Fax: City: 7 +e r-Ce, State:-:7
Phone N'o. Zip Code: Fax: °'t'i a--`��8-dz"7 a-
E-Mail: Phone 4o.-!!-1 Z - q4.1?- a 7 b-z--
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State o County License: CCC_ 4 "S7% D6L q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW IN'FORMA 10,N:.
DESIGNER/ENGINEER: _Not Applicable MORTG GE 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
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Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/;CONTRACTOR AFFIDVIT:Application is hereby made to obta n a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of permit.
St.Lucie County makes no representation that is granting a permit will autho ize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,byla s or and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review yo�r 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.Lu ie 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 m ist be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
cornmencing work or recording our Notice of Commencement.
Sign 4o- wner/Lessee/Contractor as Agent for Owner Signat r of Contractor/L"icense Holder
TATE OF FLORIDA STATE F FLORIDA l
COUNTY OF COUNTY OF �7i'•� C�..
The forgoing instruanent was acknowledged before me The f rg ing inst m t was acknowledged before me
this day of 201%by this day of 20121 by
Name of erson making statement Name of person making statement
Personally Known' OR Produced Identification Persona y Knower OR Produced Identification
Type of Identification Type of I Jentification
Produced Produce
S' atl re of Notary Public-State&Florida) (Si re f Notary Public-State of Flo da)
Commission No. (Seal) Commis ion 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