HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE A EPTED n I�
Date: P rmit Number:
r
Building Permi 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:
PROPOSED 1�M I P.,IT MIA EMEINS T LOCATIC*)N;
Address: PoraS% V
Legal Description:
Property Tax ID#: 1 S 0 1 - S-O o o z Lot No.
Site Plan Name: Block No.
Project Name;
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRPTfON OF UVORK.
Y3 Lpld& C3 N 1 0`f Or
=SIMSTRII f 1 11 O:i I ON:
Additional work to e_pe. orme under tis permit=check a t a appy:
Vit/Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft'of Construction: Sq. Ft. of First Floor:
%
;Cost of Construction:$ 3 ki , Utilities: —Sewer —Septic Building Height:
M00:81111 E: C0 TRACTOR:
Name L-1 15, S10P-�� I-? Nam G S co A"-M
Address: CD J ti--,� MM A-c�rJ S' Com any: 2.PS C,oR-
City: T�() State:i Addess: I3t4 LA-JCM fin- 121
Zip Code:1 C.t o2QA Fax: City: Y/J i?9 ;,1 &�1`cm State:
Phone No.("XW- Pr-p - 3 �
3-1 S_ C — Zip ode: � �{ Fax:
E-Mail: Pho e No Sip l - f3 _Dl`-43 0A3
Fill in fee simple Title Holder on next page(if different .E- ail PJSf'OAg?C�f 3.efl Q C,/r7,W L . CO/-7
from the Owner listed above) Sta a or County License ( ,tree 1%1 66 t J
If value of construction is 2500 or more,a RECORDED Notice of Comm ncement is required.
S�IPPLEM'ENTAi. C NSTRUCTIQN TEN LAUII INFaRM TION;
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
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 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
commencing work or\recgr4ing your Notice of Commencement.
Signature of Owner/Les ntractor as Agent for Owner Sign Contractor/License Holder
STATE OF FLORIDA CC� l STATE OF FLORIDA
COUNTY OF COUNTY OF ,
The f rgoing instr ent was acknowledged before me The forgoing inst ment was acknowledgbefore me
this day of 20M by this 2 day of 20_M by
�{ZO.f1�S�c0 ��ca�-a. �a,.rtic�5i ccs co$�
Name of person making statement. Name of person making statement. \.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi n Type of Iclaaffica n
Produced Produced
_'utary r�rnr� ce.,
( ' ature of Nota i'' I -e1 p£6tonidar),res DOC-20,2018 (Signature o Notary' .ublic-State f Florida)
ty c um u. L•, s rc'?U,201 U
Commission FF 177248
"�����" Bonded thro ;F °c'- Commje, n F�77249
Commission No. '(Sd;;I')onal•NotaryAssn. Commission No. o,OFF-?: $ell
Bonded throi�jn Natiunatary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17