HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE A CEPTED.
Date: P rmit Number:
Building Permi Application
Planning and Developm,'ent 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:
PROPO� ED INPROtIEMEKIN KC!AT
Address: L1606, Eqale. ice• T• P. ',eY25
ce-
Lega Description: -ti le Is 76:16-s 10 * 0Q3
Property Tax ID#: 01— 00,3 7. ODO - Lot No. ?0
Site Plan Name: Block No.
Project Name: e YX
Setbacks Front_ 0V Back:_�Right Side: JO Left Side:
DETAILED DESCRIPTION QF U1/®RK:
e,
C®NSTRt1CTl®N I'NFORNIATI®N:
Additional work to be performed under tispermit-check all'that apy:
_Mechanical _Gas Tank —Gas Piping hutters _Windows/Doors
_Electric _Plumbing _Sprinklers Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
od � (
Cost of Construction:$ , 6 c3 p Utilities: _Se er _Septic Building Height:
®UlINER/LESSEE CANT ACTOR:
Name J&mom C .oyy 4 e4 Name: �G-
Address: L1604 IEAQ){ Dc Compa y•
City: " . e- State:EL- Address:
Zip Code: 3AUXI Fax: IV 1# City: .�CJlrG if State:--,EL
Phone No. - s- 7 o Zip Cod 3 Fax: 772
E-Mail: Phone o. ;77.2-
Fill in fee simpl Title Holder on next page (if different E-Mail: O . L II L IV vo O. 60
from the Owner listed above) State or County License: ez - -S
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
Sl'JPPIEMIE!N CO'NSl"RACTIO"N LIEN IA, �p
�W INFORMATI®N.
r _ .. s
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: of Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: ___�iClot 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-1 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 recordin our Notice of Commencement.
Si nature of Owner/Agent/Lessee JkKatu `of Contrac Lic ,se Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20_ by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-.State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal)- Commission No. - .(Seal)-
REVIEWS FRONT ZONING .SUPERVISOR PLANS VEGETATION SEA TURTLE '.MANGROVE
COUNTER REVIEW..,•. .REVI'EW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED _
Rev.