HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number.
F-1
Planning,and Development Services Building Permit Application
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34.982
Phone:V72)462-3553 Fax:(772)462-1578 Commercial es Residential
PERMIT APPLICATION FOR: To Select from dlopbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: . 10 4/ 8rddw-
Legal Description:
Property Tax ID#-. Lot No.
Site Plan Name: Block No.
ProjectName:
Setbacks Front Back: Flight Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Addiffortal work tobe nertormed under this permit—check all t=apply:
E1HVAC []Gas Tank [:]Gas Piping UShutters F]Windows/Doors
/&Electric El Plumbing []Sprinklers Generator ORoof Root pdch
Total Sq.Ft of Construction: SQ.Ft.of First Floor.
Cost of Construction:$ ?Ao- - Utilities:nSewer nSeptic Building Height:
--OWNER/LESSEE.-,�(,)61,t4 D6L),aJ0r)M CONTRACTOR:
Nam Name: Y1OM
V
Address: , G9AA 1110,e(,, Company:
City: b IS i2,,A6 State:Zt. Address:-JE05D
Zip Code: Fax: State:
City:
Phone No. Zip Code: :3:51 i�) Fax:32 �FA
.,
E-Mail: Phone No.?OE07 I 6-4
Fill in fee simple Title Holder on next page if different E-Mail:dhmasaW% 0AYVJ
U
1rorn the Owner listed above) State or County License:Lgf
-if value of construction is$200 or more,a RECORDED Notice of Commencement is required.
-S,VPPLEMENTALCONST6tUCrION bEN- AW-1NF0RMAT,1gN:;
DESIGNERIENGINEER: _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: 1 City: j
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 snakes 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 Assoclatron 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.
j 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(Saying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the jobsite
before the fi inspection.If y u intend to obtain financing,consult ith lender or attorney before
comrnen ' ork or rec iour Notice of Commencement.
Sig atu ner/L ntractor as Agent for Owner Signa ontractor/License Holder
STATE OF FLORIDA,���,•,�/' I STATE OF FLORIDA
COUNTY OF fC `E'rn COUNTY OF
The f oing I Acknowledge ore rrte The fo Ding in n n s ck�n�owlg afore me
tlu day of 201 C by j this day of lVl 2Q by j
Name of person making statement 7� Name of person malting statement l/
personally Known OR Produced Identification Personally Known OR Produced Identification
Hype of 0d catiType of Id- cangqon
Produced f CCi�s I�PS(�?G`�i Produced �.V� rS cC,
e i
'edi_
_1tq11-9' VQAA^-'1
(Signature of NoikPublic-State of Florida) (Signature of No"
Public-State of Florida)
Commission No. ^��;v; G lIjA ELIZABETH CANALES Commission No. a tipin�.;; ($f INA ELIZABETH CANAL
" "`� Notary Public-State of Florida :'.OEM&,
Notary Public-State of Florid
( l( f ; k•? yCommission#GG 124400 f ( '• • yCommisslon#GG 124400
1 Vl .'y �s M Comm.Expires Nov 11,2021 (OIDU( 1' M Comm.Ex ices Nov 1 t 202
aondedlhoughNatianallotary Assn. Ilan dlhroughNationalNotaryAss
REVIEWS. FRONT �,mI S R PLANS VEGETATION
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
BATE i
COMPLETE®
Rev.8/2/17
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