HomeMy WebLinkAboutREVISED 1811 0362� 9,0\ilNla,�
ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED)
Date: 1- I�' o Permit Number:
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Building Permit Application
Planning and Development Services
Building 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 line
PROPOSED IMPROVEMENT LOCATION: a
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Address: f�� 0 . I
P I 1 -1
Legal Des cr prion:
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Property Tax ID 4: L42iD SDI QQI ( CQQ
Lot No.
Site Plan Name:
Block No,
Project Name:
Setbacks Front Back Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Aclditiq,07 work toe e orme under this permit — check a appy:
HVAC 11 Gas Tank ❑Gas Piping Shutters
E]Windows/Doors
_ _
0Electric E Plumbing Sprinklers Generator
Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
r1l #1
Cost of Construction: $ Utilities: Sewer E]Septic
Building Height:
OWN ER/LESSEE:
CONTRACTOR:
Name JQ,
Name: EaJwik
Company:'
V
Address:
City: State: _LL
Address
City:
Stat
Zip Code: Fax:'
QQ
Phone No. � - `t���
Zip Code:. PF
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E -Mail:
Phone No.5
E-Mail:
C V. Coln
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
MIN ' NE60
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: s 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. LucieCounty 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, coppult with lender or an attorney before
comme ini work or recording our Notice of Commenceme
gnalVp6 of Owner/ Lessee/Contractor as Agent for Owner
g
Sign ur of Contractor/License Hoider
STATE OF FLORIDA
STATE OF FLORID
COUNTY OF��,Q� o
COUNTY OF
The ing ins r m was acknowledg before me
ing instr wa a knowledg efore me
TheLIT
this day of 20'q by
thisday of M 2flby
ryt fl. QJ( i Lek, M i 1 [L
c l
rs n making statement
so making statement
rsonally Known OR Produced Identification
ersonally Know OR Produced Identification
Type`etide won
Type i kation
Produced
Produced.
(Sig tune of Notary Public St t-F�orr Ali
( nature of Notary Public State A14
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17