HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Elate: I' Permit Number.
s
Building Permit Application
Planning and Development Ser4%ces
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
PROPOSED IMPROVEMENT LOCATION:
Address: � vle
Legal Description: esf-� ee �7)Lt ;), �=t
Property Tax ID#: - Tl O k 00"3 5 � �=`= - � Lot No.
Site Plan
[l[Name: Block.No.
Project Name:
Setbacks Front Rack:. Right Side: Left Side:
DETAILED DESCRIPTION OFWORK:
fir} CZ�s't a- M-�- Ce,-.,
C1 rez C_
+; CONSTRUCTION I INFORMATION:
Additional work to be erformea under t ►s permit-c ec a apply.
11_HVAC Gas Tank Gas Piping _Shutters �Windows/Doors
LJFlectrpc Plumbing 115prWders generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
COST Of CVn%tfU(Ai[ln. $ � t�J Utilitio-s_Insew.-r 01%pptir Ruildine Height'
OWNER/LESSEP CONTRACTOR;
Name Ache 22 Name:
Address: j � �i�I/illc. � Company: U.,A-ic � t
City: . State;CIL
Address: ---
Zip Code, 3Y Fax: yA/ 1-- { City-
Fax: r s�Zt State: 1�C
Phone No. - Zip Code:----� �l� Fax:
Phone No.
Fill in fee simple Title Holder on next page( if different E-Mail: C1( A—Z n C C ^C ti 5f-. -1
from the Owner listed above) state or County License.-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required,
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: , Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: T
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
SEE SIMPLE TITLE HOLDER: � Not Applicable � BONGING COMPANY:T 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 guild 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 Hoare Owners Assodation 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 apphcatiQns 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 he recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with leader or an attorney before
commencing work or recording your Notice of Commencement.
Signatur nerf Lesse aactor as Agent for Ovvme g►t re ra "cense Holder
OF FLORIDA E OF FLORIDA
COUNTY OF S± f e COUNTY OF - 1-11 C-,-c
The forgoing instrum nt was acknowledged before me t The forgoing instrument was acknowledged before me
i this day of_ do 20 1 Y by � this 3! 't-day of vl 20_Lj� by
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Name of person snaking statement � Name of person making statement
Personally Known_ �_OR Produced Ide I r,3 a'a�ra Personally Known OR Produced!dent c
Type of Identificatio; =•�"5•*" y ( Type of Identification k
Produced Produced
o 4 a
rco'm
nature of Notary Public State of Flcrld 3 D �S ltre gf Notary I�ulicState of Floridmission No. F l On No.
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REVIEWS Fi1LJtY7 L. 9tli1V ASE92tIF. i�LV. � C{A[�iS1= #A15i..11+f S Ft C! 4ANGROVE
COUNTER 'REVIEW «f�iVIE�; REVIEW REVIEW i REVIE EVI;=W
DATE
I RECEIVED I
I DATE
I COMPLETE l
Rev.s/2/z