HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION-TO BE ACCEPTED
Date: 741ir Permit Number:
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_ Building Permit Application r-; n,-,,I '
Planning and Development Services � ) '' ®r
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 " YJ .
Phone: (772)462-1553 Fax: (772)462-1578 . Commercial Residential_
PERMIT APPLICATION FOR:
P'R�(�3POSE� INPROUEME T LOC TPC} .
Address:
Legal Description:
Property Tax lD#: 3�I y- �30 '�ay7 - C9c70- � Lot No.a(>
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional wor to be pertormed under this permit-check all t at appy:
_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:$ c19 (9 Utilities: ",-,Sewer -/ Septic Building Height:
OW ERjLE�S� ESE: CONTRA�OR:
Name o, z a �v>`�-o Name:
Address: 4- Company:�����' ` �"<Prn S��vTccJ� fisc
City: Stater Address:(-/la0 A?
Zip Code: ILI9, Fax: City: PfC State:4;5;7(
Phone NoT," - C 2?-0 71 Oe Zip Code: IC/79.t Fax: 7 2 44k� -7 77J�
E-Mail: A1111L Phone No Lal - qL(((
Fill in fee simple Title Holder on next page(if different E-Mail T
from the Owner listed above) tate r County LicenseCrC I
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
LE EN L CQ�1S?'RtJC.�TfON L ., !AW I' '{ R.NfAT1"� N:
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
commencin work or recording our Notice of Commencement.
7ATE
ure of Owner/Lessee/ContractorJbe
Signat- e of Co ractor/License Holde
OF FLORIDAS TE OF FLORIDACOUNTY OF UNTYOFThe fo going instrum nt was acknowleThe for oing instru ent was acknowledged befoco
this da of27, �y this day of 20 by ®�_/// , CLP
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e of person making statement. a of person making statement. :•:':".
Personally Known OR Produced IdentificPersonally Known OR Produced Identifi ;
Type of Identification LJType of Identification '
Produced Produced
(Signature of Ytary Public-State of Florida U (Signature of N ryPublic-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17