HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Date:
- - Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
_
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ________
PERMIT APPLICATION FOR-:'-) pd1 n
PROPOSED IMPROVEMENTLOCATION: �
Address: W
Legal Description: i�
i I E 0 Mw 9 03
Property Tax ID #: 0
Site Plan Name: c� S
Project Name:
Setbacks Front
Back: Right Side: Left Side:
FDET:ILED DESCRIPTION OF WORK:
Lot No +3
Block No. i--1—
CONSTRUCTION INFORMATION:
WE1itiona wor to f!'Gas
orme un er t is permit — c ec a aPP Y�
Gas Piping Shutters O Windows/Doors
HVAC Tank P g —
0 Electric 0 Plumbing Sprinklers
Generator � Roof EZ2 Roof pitch
Total Sq. Ft of Construction:
'�IS S. Ft. of First Floor:
Cost of Construction: $ _ 7,_O b d - 0-0 - . Utilities: — Sewer El Septic Building Height:
OWNER/LESSEE:
Name
Address:
City: �� ^ t' State:-
Zip Code: '-AO%567. Fax:
3'
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: ` _�•_
Corn pany:�O�—
Address:
,l UCS v State:.
City rn� �
Zip Code: '2� Fax`l—'C�.'
Phone
E -Mail:
4�D
I State or County License:
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
FEE SIMPLE TITLE HOLDER: �i Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
X Not Applicable
State:
J_Not Applicable
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..
er to
re
St. Lucie County makes no represental Association oni ruleswill aby aws or and coveuthorize the nants that may drestrict the bor prohibit such
which is in conflict consult
any app
structure. Please consult with your Home Owners Association and review your deed for any restrictions
y
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
encement may
in your
ce for
WARNING TO OWNER: uR: ou A to Record a Notice of Notice of Commencementmustmust be recorded atnd posted paying
the rjobsite
improvements to yo property.
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. -
Signa re of Owner/ Lessee/Contractor as Agent for Owner I Sign re of Contractor/License Holder
STATE OF FLORIDA J > ,�/�
COUNTY OF �j / �
The f going instrum t wa acknowledged efore me
this day of 20ZI by
,Cam , .A. _'Sc ^_
Name ofp rson making statement
Personally Known OR Produced Identification
Type of Identification
Produced
ature of Notary Public -
Commission No.
REVIEWS FRONT
COUNTER
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
�P orida ) MARKKENNY
i.N
SW��ission # GG 144499
�< (ires September 19, 2021
of f�0� Banded Thru Bud98t Notary services
STATE OF FLORIDA P / / 7C,C�
COUNTY OF l
The forgoing instrurT� nt w s acknowledge fore me
this day of oG(J� 20 y
(�r.S
Name of person making statement
Personally Known k OR Produced Identification
Type of Identification
Produced
re of Notary Public -
Commission No.
�frF ida ) MARKKENNY
o Commission#GG14449�
�� k frq r"s September 19.20i
OFf�oQ SWedTtuuBudoNotary Servic,
ZONING SUPERVISOR PLANS I VEGETATION SEATURTLE MANGROVE
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