HomeMy WebLinkAboutBuilding Permit ApplicationALL{APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
8uiiding 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 fine
PR POSED IMPROVEMENT LOCATION:
4ddr sd L'(
_egal�Ds:escription:
Pro rty Tax ID #: rd tl ( ! - R3 I X67, Cop -
_. Lot No.
Site ;an Name:
Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK;
V t. ,,J
CONPTRUCTION INFORMATION:
-'a FcJ 1 1[16 — LI
HVAC Gas Tank OGas Piping
]JElectric Plumbing Sprinklers
Total $q. Ft of Construction:
Cost of Construction: $ `7
OWgER/LESSEE:
Block No.
Shutters I] Windows/Doors
Generator 1:1 Roof Q Roof pitch
Sq. Ft. of First Floor: _
Utilities: 1:1Septic
Names �-- � .I
Address: lt3 9 S 3-7'
City: Y • €o ee e Stater
Zip Cc de: 7
Fax:
Phone No.
E -Mail:
Fill in ee simple Title Holder on next page ( if different
from t e Owner listed above)
CONTRACTOR:
Building Height:
Name: 40 Q' or
Company: - Cin
Address: OlL�,.,,�,,,�
City: r- r 3 • C r fe. State:'L
Zip Code: 3L(9 s'!z- Fax: Li L(- (i 7
Phone No.
E -Mail:
State or County License: - C 8-( -3& k
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
Ad
PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
e:
— Not Applicable
State:
Phone
SIMPLE TITLE HOLDER: i Not Applicable
Hoaress:
City:
Zip; Phone:
MORTGAGE COMPANY:. _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:.
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I cert fy that no work or installation has commenced prior to the issuance of a permit.
St. Lu ie 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 cony ideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in acc rdance 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
befo a 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
STATE OF FLORIDA
COUNTY OF J -
The for Ding instru ent was ack owledged before me
this da of ,■., 20111 by
r
Narfie of person TAing statement
Personally Known !/ OR Produced Identification
Typelof Identification
of Notary c- rida) •y...w
too,,,, 'I Aflt'rti t: Vv .a�oi
1 No. ry Notarilic Sate of Florida
Commission # FF 216951
• My Comm. Expires Apr 5, 2019
11115
FR Z NIN G 5UPERVIIS R
COUNTER REVIEW REVIEW
RECE VED
DATE
COM)LET
Rev. 8/2/17
Signature of Contractor/License Holder
STATE OFFLORIDA
COUNTY DF- ,! mac. •-_
The forgoing instruipent as a knowledged before me
thisday of r 20L5 by
(tame of person making statement
Personally Known L_�' OR Produced Identification
Type of Identification
Produced
(Signature of Notary Pu
Commission No.
. MIKE MARTIN
No �aTIc - State of Florid
mm sion # FF 216951
My Comm. Expires Apr 5, 201
3ondcd through Mational Notary As
PLANS I VEGETATION I S REVIEW LE MANGROVE
REVIEW REVIEW