HomeMy WebLinkAboutchevronALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 467-1553 Fax: (772) 462-1578 Commercial Residential
Address: L
Legal Description:
Property Tax ID #: /3
u 0 3 to Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Adclith')Ihal work to a er orme under
,�48UAC _ Gas Tank
Electric ❑ Plumbing
Total Sq. Ft of Construction: IeLEc!)
Cost of Construction: $ _ bvz
permit - ch ec c a I I that appy:
Gas Piping _ Shutters
Sprinklers ❑ Generator
Sq. Ft. of FirstFloor: _
Utilities: Li Sewer DSeptic
Windows/Doors
❑ Roof hoof pitch
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name ��^-, �r f :"
Name:
Address: 7 , L 011-)C In
Company: �c.�=
n r,
City: State:.e
Zip Cade: Fax:
Phone No.
Address: `-/ 5 ry
r-
+State:
City:
Zip Code: -3 � SJ' 3, _
Phone No._�
i L
Fax:
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: 6�•
State or County License: C.
^, ,, �'-, _
C_ j.F e4—:7
.....UC v. UW11a.1 U4L,LP11 ap ?fauu ur more, a ncwnutu notice oT LOmmencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 recording our Notice of Commencement.
Rev. 8/2/17
ignature of Owner Lessee/Contractor as Agent for owner
fignature of Contractorf License Holder
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF ;% C
The forgoing instrument was acknowledged efore me
Yby
The forgoing instrument was acknowledged , efore me
this � day of / x ,r,,� r 20 r
this -L!-day of ((�. , . . 2p -by
Name of persogmaking statement
Personally Known OR Produced Identification
Name of persop making statement
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced e81er Tb
Produced
NOTARY PLIBLIC
Homer Tio
4n STATE OF FLORIDA_
NOTARY PUBLIC
`'
1 STATE OF FLORIDA
(Signature of Notary Pub a cEJ* ridaly25=19
Signature of Notary Public- Stat a res 1i2512019
Commission No.Fj- 192_52 3 (Seal)
Commission No.E(-- 1 92-'5 228 (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