HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
Building Permit Application
Pionning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462.-3.578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: .- 1 kk
Legal Description: GCS l� 10 LCILLY1w
Property Tax ID #: 1 U E CA CSU
Site Plan Name:
Project Name: �° +��
ac u,r"� �.
Setbacks Front Back: Right Side: Left Side:
Lot No. e l
Block No.
DETAILED DESCRIPTION OF WORK:
cm c. %A 6 NQ'+ -cam �+.r'd k�,�> --� i � �e L) ` -f ���`�' 'v' - �� Jr►'%��.1 l .
CONSTRUCTION INFORMATION:
Additional work to be nertormed under t is permit - cleck all appy:
0HVAC Gas Tank F]Gas Piping _ Shutters windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ ila) C'
S Ft. of First Floor:
Utilities:Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name:' 1.5 JT4��'�l.L'r91 er?
Address: l S)- (_.c;5 L�)j c� 0Q-
Company: i! ) ✓;�
City: State: ' 6-.
Zip Code: L ) S Fax:
Phone No.
Address: c' I i!V J �� en SCJ' 1 's i yG
City: State: �` Z
Zip Code: G �` Fax:—/ -?3
Phone No. _1�Z- 44 el l 1' 5
E -Mail: kti� ; {
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: JCr-v'w CSS f'roj ,�C=' L)()' � it
State or County License: C'6 I ja I
If value of construction is $2500 or more, a RLCURUtU Notice of commencement is requireu.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.
1 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 ip�pection. If you intend to obtain financing, consult with I der or a --attorney before
commencin>; vy6rk or re��ng your Notice of Commencement.
ure of Owner/ Lessee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORIDA . I STATE OF FLORIDA
COUNTY OF C � _'_r4- COUNTY OF 0 \n_' ��
The forgoing instr4m,ent was acknowledged before me The forgoing instrument was acknowledge�,before me
this `tom day of \ ,'L� v J 201 by this I Z� day of TJc��r�r �� 20( Eby
rite of person making statement
'Personally known OR Produced Identification
Type of Identification
Produced
(Signature of Notary P Lsb aM&Wi?IELINSKi
'•: :.- Commission # FF 926792
Commission No. yam..,. • Expires Od& 13, 2019
911ded TF- Trey Fain lnu--" 6X3.45.7099
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/37
RCS Z-1—+
Name of person making statement
Personally Known =?< OR Produced Identification
Type of Identification
Produced
(Signature of
a— Commission (1792
Commission No. _ • c -
fF Aires October 13, 2019
' P,° Rr. Banded Thm Troy Fain Insumea 600385.7099
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW