HomeMy WebLinkAboutBuilding Permit Application 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE.ACCEPTED
Date: Permit Number:
tea. . . ..
--Building Permit Application-
Planning
p lication Planning and Development Services
Building and CodeRegulation Division
2300 Virginia Avenue,Fort-Pierce FL 34982 -
Phone:-(772)-462-1553---Fax:-(772)462-1578 'Cornrnercial Residential ''
i •
PERMIT APPLICATION FOR: To Select from dropbox, click arrow.at the_end of line
PROPOSED IM_�PROVEMENT'-LOCATION
Address: It L&R `Vifc7
Legal Description:
Property Tax ID#: 1,3. 1.2-;,:- 0 1 00 -7 6 — 0 U —S Lot No.
Site Plan Name: Block No.
Project Name:,
Setbacks Front Back:. ' Right side: Left Side:
DETAILED DESCRIPT,ION•OFWORK
(��3-m� 3 � s--...__-.:inn•. : . w ew- . ;•s�c�ee.n _ e��:I�s�!'c.. -- - �. .- - - _.
CONSTRUCTION INFORMATION
Additional work toe performed under this permit—check all ttiat apply:
nHVAC - Gas Tank FGas Piping -]Shutters - Q Windows/Doors
EElectric 0 Plumbing 0-Sprinklers 11 enerator E Roof Roof pitch
Total Sq..Ft of Co'n`struction: S Ft.of First Floor.:•
Cost of Construction',$",, ,at��.:� Utilities: Se er Septic Building Height:
L - .t``
OWNER/LESSEE b,' ,s'h L.. . r, , {
• - CONT ACTOR' -""
!Name Al( e�-+ Name:
!Address: VA 6 W}A�P64e.. D Compa y: WO(`04- 2- i nL
;City: . D ITS M 6 0`[ State:-Q I Address: n4al\e4k
Zip Codec,.0,2 cL-.l l Fax: City: l�e(`c� State:.rJr
Phone'N6. I o I 3 S ' g 2 o 0 Zip Cod q. LI .7 Fax:
E-Mail: S�d-`f �I g 3\ 7�a 01 , COrA Phone o. 7 7 -L — G -- o S G 0
Fill in fee simple Titie Holder on next page(if different E-Mail: W tV0\v 2 ,�(1G �0 t corms
from the-Owner listed above) State or County License: G [ U o Z.S I 2 .
If value of construction is$2500 or more,a RECORDED Notice of Commenc ment is required.
SUPPLEMENTAL CONSTRUCTION. LIEN LAW INFORMATION:.
DESIGNER/ENGINEER: . =Not Applicable MORTGAGE COMPANY: _Not Applicable "
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Rhone:
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 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 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 iri 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 recording our Notice of Commencement.
Signature of Owner/Lessee/ ontractor as Agent for Owner Signature of Contractor/Licinse Holder
STATE OF FLORIDAcryFLORIDA
COUNTY OF— .� COUNTY OFyC�
The forgoing instrumgrit was acknowledged before me The fprgoing instrume(�t was acknowledged before me
this day of UM 20j by this��1 day of ,1 uE�t ;_201!j�by
e of persori making statement f erson making statement
.Personally Known OR Produced Identification Personally Known OR Produced Identification
TypeOT cation y ton
Produced Produced
—NotaiyPublie state or FMride .�*Y Notary Public State of Florida i
Chris L Woolley +� Chris L Woolley.
,4 �, My Commission OG 185986 My Commiagion ad 1 asses,
�0&dF Expires 0212612022 Expires 02126/2082
(Signature of Notary u Itc-State o F orida (Signature of No -
Commission No, r�. � - (Seal) Commission No. / 6 b. (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