HomeMy WebLinkAboutBuilding Permit ApplicationALL 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 3495.2
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: q 1 l i 5a"Ck `
Legal Description:. Cosli.e 'Roo -es 4- L/ 3
Property Tax lD #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks 'Front Back: Right Side: Left Side:
[DE�AILED DESCRIPTION OF WORK:
LCONSTRUCTION INFORMATION:
orme un ert is permit --c ec a tat appy:
Additional work to MGasTank
HVAC ❑Gas Piping ❑_ Shutters Windows/Doors
DElectric Plumbing O Sprinklers Generator L=l Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 1 0�5 Utilities: E]Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name GSA?N -1�1-e- �19—
Name: A✓ ;yr?-�vU .
Address:3 Y V - nuli'c ro- �—wf
Company: 'eh
City: J Stater
Address: (';' f
Zip Code: 3 � 99f�> Fax:
City: P -S L State: r—z -
Phone No. -77,2— '4 '�> " C15
Zip Code: 3 Fax:
E -Mail:
Phone No. 7 - s % `6' -,
Fill in fee simple Title Holder on next page ( if different
E -Mail: eop-14 1)in isyO CA 0. Gv i "—
from the Owner listed above)
State or County License:
Commencement is required_
If value of construction is $2500 or more, a RECORDED Notice of
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 wording your Notice of Commencement.
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contra r/License Holder. ry
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The f%'going instru nt, ,a- acknowledge efore me The forgoing instryfint1 asiac now ledge efore me
this day,of[�' 2Dby this day # 20 by
Name of person making statement Name of person making statement
Personally Known -,OR Produced Identification Personally Known OR Produced Identification
Type of Identifi libn Type of Identificat'
Produced Produced
{gnature o Notary u lic-- ZftQorida) ETIi( Nemo�a {Sig tore of Notary lir lorida } Edk Nemoga
Com GG101442 Contm�sion i �GG101442
Commission No. _` ?F Se 4, 2421 +�
i . { �y Commission No. 4 • ; �``$��S: May 4, 2021
9Mdedthru Aaron Notary f„���,►ti��� Bonded thrlf Aaronfotary
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED -
DATE — — - — --
COMPLETED
Rev. 8/2/17