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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED DateAL ,(=,u!�5F LP.0 ZQwl�s Permit Number: �. 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 PROPOSED IMPROVEMENT LOCATION: Address: 1 D D t S OCE -AN- Df LLAT— 4 16 L4 iLp Legal Description: VEJNP-(J-D 5 (N IT_ sr—C-71 CKI Property Tax ID #:4511. a ©1j• 004-7, 6)00• Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DETAILED DESCRIPTION OF WORK: CONSTRUCTION INFORMATION: Additighal work to be nerformed under t ispermit - check all appy: NHVAC LE]Gas Piping Gas Tank _ pin g Shutters ❑Windows/Doors ❑ Electric ❑ Plumbing ❑Sprinklers ❑ Generator ❑ Roof Roof pitch Total Sq. Ft of Construction:: S Ft. of First Floor: Cost of Construction: $ 4t �n Utilities: Sewer ❑ Septic Building Height: OWNER/LESSEE: CONTRACTOR:` Name I Name: re6�, Compan Addr ss: Addre s 10_7 Q I S. t)L—f'tQ wT City: , - i�� State: _ Zip Code: Fax: Phone No. Cit Zip Code: PhoneN . State: Fax E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) E - MailEN l State or County Licens If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: DESIGNER/ENGINEER: _ Not Applicable Name: Address: City: State: Zip: Phone MORTGAGE COMPANY: Not Applicable Name: Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable Name: . .......... BONDING COMPANY: Not Applicable Name: Address: Address: City: Zip: Phone: City: 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 thepermit 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, perforin 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 t obtain financing, consult with lender or an attorney before commencing work-,of)recording yopr i . of Commencement. Rev. $/2/17 Signature of Owner/ Les /Co ractor as Agent for Owner Signature of Contractor/Li n Holder STATE OF FLORIDA COUNTY OF l n��� Nj STATE OF FLORIDA COUNTY OF �" A- PM k1 { The or g inst n a led efare me The or ing ins r s c owled efore me this d y of 2. by thi d y of —'� ` 2 b 6 Nameo erso king statement arae 'of-p&V th-9- maki g statement Personally Known OR Produced Identification Personally Known V OR Produced Identification.__^ Type of Identification Type of Identification Pro du d Produced (Signature of Notary Public- 5t to f Florida) (Signattu�tre of N}�o^ota-ry ubiic State f 'lorida ) Commission No.lr t 'r':ea Nb. i CRYSTAL MARIE Rs�on !�. CRYSTAL MARIE CRUZAD ' MY COMMISSION # FF99321 7 �[�: MY COMMISSION # FF9932 >> 8-0153 FrorldallotarySe ce.com c. ,.�'` EXPI ES June 25, 2020 REVIEWS FRONT VEGETATION I"' TLEF COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. $/2/17