HomeMy WebLinkAboutBuilding Permit Application f ,
p:ALL APPLICABLE 1i11F0 MUST BE COMPLETED FOR APPLICATION T BE ACCEPTED
Date: Permit Number:
Building Permit A Plication
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, cl k arrow at the end of line
PROPOSED IMPROVEMENT.LCOCATION:
Address: ('7015 WEIR— G
Legal Description: UCS Lot
Property Tax ID#: t ! ' --bb27 -000`2— Lot No.
Site Plan Name: �-+ Block No.
Project Name: iy C I V-) ��1.1L+ f�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF.WORK
-'0)SJGi.[tQ4_ i6n C4 ACCoYCtc Un I f+C ren e e ve4"N
S
CONSTRUCTION INFORMATION; .
Additional work to lens orme under this permrt-c ec a
❑HVAC L_I Gas Tank Gas Piping ers {�Windows Doors
❑ P g i(w�..t /
FlElectric R Plumbing ❑Sprinklers rator L=1 Roof Roof pitch
Total Sq. Ft of Construction: /� Sq. Floor:
Cost of Construction:$1�� (J UV Utilities:0�7SeerF]Septic Building Height:
OWNER/LESSEE: CONTR .CTOR;
Name Name:
Address:Hb-i5 I f ur V,� Company it'1C,•Z_ir1�l
City: �J j ' State: Address: U�} `; Yl SQ.
Zip Code• J Fax: City: Ll� State:
Phone No.__7'�2- 7, �70 SO4 i Zip Code:I_349 22t ,e _._ Fax:
E-Mail:C010-(n I t CQ VGd/_CQ--0fY'_) Phone Nnk�WS
-7-)L- -t a
Fill in fee simple Title Holder on next page(if different E-Mail: (n(�rfti
from the Owner listed above) (State>r C unty License: la Q -�Jv
if value of construction is$2500 or more,a RECORDED Notice of Commencem nt is required.
DESIGNER/ENGINEER: Not Applicable MO GAGE COMPANY: Not Applicable _
Name: Nam
Address: Addr ss:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONING COMPANY: Not Applicable
Name: i Name
Address: Addre s:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to o tain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance f a permit.
St.Lucie County makes no representation that is granting a permit will aut orize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,byl ws or-and covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review y ur deed for anyrestrictions which may apply.
In consideration of the granting of this requested permit,i do hereby agre that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.L cie County Amendments.
The following building permit applications are exempt from undergoing a II concurrency review:room additions,
accessory structures,swimming pools,fences,waifs,signs,screen rooms an accessory uses to another non-residential use
WARNING'TO OWNER:Your failure to Record a Notice of Comme cement may result in your paying twice for
improvements to your property. A Notice of Commencement ust be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, co suit with lender or an attorney before
commencing work or recording our Notice of Commencemen .
Signatu a of Owner/Lessee/Contractor as A nt for Owner Signatur of Contractor/License Holder
STATE FLORIDA STATE F FLORIDA
COUNTY F COLIN OF
The forgoing strument was acknowle ged before me The f r ing instrume t was acknowledged-before me
this day o 20_____ by this day of, 20by
r
Kan4d
Name of pe on making sl6tement ame of pers n making statement
Personally Known OR Pr•duced Identification Personail Known `V OR Produced Identification
Type of ldentlfication . Type of id ratification
ProducedN Produced
Sign ure
of Notary Publi a of Florida) klpr of Notary Publi te of Florida j
Commis ' Commi al)
mar P4B4� Notary ublic State o Iorida ar Pug` Notary Public State of Florida
' Liza Mayfield a ^ Liza D Mayfield
3
?or � Expi s 07 3U,019 ��
REVIE r SUPERVISOR PLAN EJVJy
go ex ires0713 12019 MANGROVE
COU TER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED 1
DATE
COMPLETED
Rev.8/2/17