HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date `CS_ Permit Nu bei-- �$_J
EIVED
AUG 2 8 2,918
Building Permit Applicatio T. Lucie County, Permitting
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line C
PROPOSEDIMPROVEMENT LOCATION:
Address:
V �QV12� �-3 Yw5
Legal Description:
Property Tax ID#: .\ Lot No.
Site Plan Name: Qv` Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION"OF WORK:
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CONSTRUCTION INFORMATION
Add rtion workto e e orme under this permit-c ec a appy:
_HVAC 0 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
OElectric E]Plumbing Sprinklers E Generator 1:1 Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 5 Utilities:liSewer Septic Building Height:
OWNER/LESSEE. CONTRACTOR:
Name v Name:Z' \i
S
Address:- &. Compa
City: State:_ Add sSZip Code: `' JFax� I City: �— Stater
Phone No.11l 'l' S- :w'IN Zip Code:��J�� Fax:
E-Mail:�J(i 1 Phone No. -nkA
Fill in fee simple Title Holder on next page(if different E-Mail: ALT
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUOLEMENTAL CONSTRUCTION LIEN LAWJNFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 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 1 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO%D� G`
COUNTY OF S-N-- COUNTY OF
The forgoinstrument was acknowledg before me The forgoing instrument was acknowledge before me
this "Aday of cN�9 .20 by this�day of O? \` 1 .20_M by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification L Type of Identi tion
Produced rC\ Produced Y
(Signature of Notary Public-State of Florida ,�. t (gnature of Notary Public-State of Florida)
5•�1�D ••• ,.� DEpeNNAMARIE GNcid? �a �p DEANNAM �ENS
Commission No. Se COMMISSION#GG 02. zCor�mission No.
''`` EXPIRES:December 16,20 0 COMPdISSION#GG 022023
F;oMX ?= Bonded?hru Notzq Publle Under vriler_+ `z• �o= EXPIRES:December 16,2020
.1.1.1.. '—'��-.
'.,SOF Fb�i`•'' Banded TPIN Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17