HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ �$ Permit Number:
s
Building Permit Application
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
Address:
Legal Description:
G
Property Tax ID#: Lk 29 -SO 7— —7 Lot No. Z
Site Plan Name: Block No.
Project Name: !QO McL y -
Setbacks Front Back: (2c4 Right Side: f I Left Side:
T2x(Y P6KOXL' Power poi_ '' coos rULLVo
Additional work to bg _performed under this permit—c eCK all that appy:
UHVAC Gas Tank Gas Piping Shutters E]Windows/Doors
Electric ® Plumbing Sprinklers E] Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. of First Floor:
Cost of Construction: $ 52 Utilities: 0Sewer Useptic Building Height:
Name U t
bName: �\oVN-1 (.tt'? 2
Address: Od bA I? _6
Company G�CiY1i Yl C
City:) - Q\%! LP . State: L
Address: 5 EYE VCS Y75 CE)
City: PGgyn [ 1 I N State: t
Zip Code: Fax:
Phone No. � iP ' 02� (�
Zip Code: (34OA(] Fax:
C
E -Mail: 'rfljVj & y -r, Qson(j. Corm
Phone No.j-1a &q—)3ZU�
Fill in fee simple Title Holder on next page (if different
I
E -Mail: W1 VJW YC,�EC i L y(6M CCC P rl4
State or County License: L 13t)U-1S0
from the owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
of
City: State:
Zip: Phone
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone
_Not Applicable
OWNER CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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. i
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
commencingwork or recording your Notice of Commencement.
Rev; 8/2/17
Signature of Owner/ Lessee) ontractor as Agent for Owner
Signature ofntractor/ icenseHolder
STATE OF FLORIDA
STATE OF FLO I A
COUNTY OF 'H j , t ,
COUNTY OF 1ylct Pi -1 K—)
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledg9l before me
this day of °'{ 20 by
this —t day of J�t l D�� 20_225'' by
�/ k M. Y
-, Name of person making statement
Name of personl mak ng katement
Personally Known OR Produced Identification
Personally Known -v�_OR Produced Identification
Type of Identification
Type of Identification
Produced
Pro d
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�r r
m f t�I
/Eig'nature
{ ignature of Notary Pub[ St to a5'.-Plt�Yeda) LAURA CULPEPPER
of Not ry Publl - • ' Flor[d� NIE LAPRADE
MY COMMISSION n PF2247
COMMISSION a FF2247
7MY Notary Public -Slate of r
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Commission No. i�•• i {RES Arid 27. 2019
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REVIEWS
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SUPERVISOR
PLANS
VEGETATION
5EA'TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev; 8/2/17