HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: m t o- , 0 ) 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: s n Bn ou i—an e, ;� T
Legal Description: Pal �,—j OIC Ii ) )1I1� : Lei_ 2F_�
Property Tax ID #: ?)4 i n q o
- cy,-;,o -
Lot No.
Name kiJ i i am j ot 1.1 me to. l (
Name: bou i d ift,M
e.
Site Plan Name: -T i m P -T j'no c, E";,t �JC_'Q_'
Company: ` i he Cn sS prof
Block No.
Project Name: '-did I RC -S I (-CLP
Address: �:Vh-1t:>
City: ��L?�z�'�
Zip Code: ,�,�C�i I
Phone No. Od- cS -
State: $'L
Fax: 17 3L 3aio -04 (b 1
C)`k-5q
E-mail: Calbi l h i I I Ln, ml'('i t . oat-
Setbacks Front Back: Right Side:
Left Side:
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DETAILED DESCRIPTION OF WORK:
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i m PCUCfi N i n6 ob_�
CONSTRUCTION INFORMATION:
Additional work toe performed under this permit - check
HVAC Gas Tank []Gas Piping
all
appy:
Shutters
54 Windows/Doors
_
11 Electric ❑ Plumbing Sprinklers
Generator
Roof Roof pitch
Total Sq. Ft of Construction:
SFt.
of First Floor:
Cost of Construction: $ . 4(_4) - Ci Utilities:
_ Sewer ElSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name kiJ i i am j ot 1.1 me to. l (
Name: bou i d ift,M
e.
Address: 7bii w na of oe_
Company: ` i he Cn sS prof
o p ,�s
City: Eb . P ierae State: Fl-
Zip Code: �i�-�r� Fax:�'�--
Phone No.CQ00 i.- -79 (J
Address: �:Vh-1t:>
City: ��L?�z�'�
Zip Code: ,�,�C�i I
Phone No. Od- cS -
State: $'L
Fax: 17 3L 3aio -04 (b 1
C)`k-5q
E-mail: Calbi l h i I I Ln, ml'('i t . oat-
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail:T�t�711-� -T(co,S`fit�6DCw(
'
State or County License:
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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:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
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 r-recordingour Notice of Commencement.
1
Signat re of Owner Lessee/Contractor as Agent for Owner
Signat a of Contra r older
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF m i!)
COUNTY OF or-inc-ti n
The forgoing instr ment was, acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20j by
this __ day of n 20 by
o
L)1 OI
l
c
J
�
1
M
Name of person akin, statement
Name of person Ing statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
L
2'u I -&
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- tate of Florida )
Commission No. '2 (}V 4- (Seal)
Commission No.( �ZT—I CC��- (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