HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �f�tPermit Number: \Mo-d(�Q y
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Building Permit Applicati0CT 3 201
Planning and Development Services permitting
Building and Code Regulation Division e county,
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 line Dd 0
PROPOSED IMPROVEMENT LOCATION:
Address: LO( M of y Ge-p— n� /
Legal Description:R- vc- �/e �`� !'�C:e 5
Property Tax ID#: 33 ZZ- 60 OO 2--1 C9 OC) Lot No. _
Site Plan Name: d SSP r\,c_.., Block No.
Project Name: 14d
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF
_WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under tispermit-check all appy:
HVAC _Gas Tank E]Gas Piping _Shutters FXWindows/Doors
Electric ❑ Plumbing OSprinklers 1:1 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S of First Floor:
Cost of Construction:$ Z-Z5c) Utilities: Ft._Sewer 11 Septic Building Height:
OW N ERAESSEE: CONTRACTOR:
Name Name4-1 '1^�c-�•a +�
Address: /0/ /9 Company: C b �,'I��s
City: State: Address:Address: 3 Z3 I 5
Zip Code:9 Fax: City: Stater
Phone No.s1�5-/3 - 52-0 - 9 fir Zip Code: Fax:
E-Mail: Phone No. 22 Z g( - 2-7570
Fill in fee simple Title Holder on next page(if different E-Mail: / .[� �i e�6 o C_O f-\�
from the Owner listed above) State or County License: Z-3 3*3
/5:92 19q7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. %.-31'Aa
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Dk,_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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signa Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF m COUNTY OF
Thio going ins ent as acknowledgfore me The ing instr nt;�vas acknowledg fore me
thi day of 20 by thisday of F— 20by
Name of persorimaking statement Name of persmaking statement
Personally Known r/ OR Produced Identification Personally Known ✓✓ OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of No ry Pu�}�c S of Florida) (Signatur of Nota ublic-Sta ri )
/
Commission No. / (Seal) Commission No. / V (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETAT :r� ,, URTLE MANGROVE
ER REVIEW REVIEW REVIEW REVIE RE REVIEW
DATE y
RECEIVED MY EIBgp
DATE �ri;,#�;�' IRE ;Nova F t7gq� P��c 2018
COMPLETED B0" Amrvo�,yp��25,201
Rev.8/2/17