HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��?g Permit Number:
P_ 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 V__�
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
_
Address: - - ` V �1_ 11RC,
Legal Dyescrtion: 4l.' �C
i
r ""�
�[ f/ �C''k l •
Property Tax ID #:` ' dc�+-�� ` Lot No. _
Site Plan Name: Alk Block No.
Project Name: "
Setbacks Front Back: Right Side: _ Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Addiflona work to be Dertormed un er t is permit — check all appy:
HVAC Gas Tank E]Gas Piping _ Shutters Windows/Doors
11 Electric Plumbing 7 Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Constructions S Ft. of First Floor:
11
Cost of Construction: $ J �3' Utilities: Sewer Septic Building Height: _
OWNERAESSEE:
; CONTRACTOR:
Name
Name: i(.►iILAs1L.
Address; C
-Company:
A ress: -
CityA A State; g4
City: Stater
Zip CodeFa -;0 C1
Zip Code:' Fax:
Phone No. `'1_1_�s
E-Mail:
Phone�-
Fill in fee simple Title Holder on next page ( if different
E-Mail k0L _ cllrk
State or County License:
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of
Commencement is required.
SUPPLEMENTAL'CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER
Name:
Address: _
City:
Zip: Phone
_ Not Applicable
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:_
Address:
City:
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone:
Not Applicable
State:
BONDING COMPANY: Not Applicable
Name:_
Address:
City:
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 Assoclation 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.
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Signature of caner/ Lessee/Cot
essee/Co r for as A en or Owner Signature of ntractor/Licens H Ider
STATE OF FLORIDA.STATE OF FLORIQA
COUNTY OF '�PN1A�>Z�_ COUNTY OF�_f 1 J 2✓�L
The forgoing instr went was a knowledg fore me The ging ins ent wa. acknowledge fore me
thisday of !�20_ o by khisday of 20_�i by
Name of person making statement
Personally Known / OR Produced Identification
Type of Identification
Produced
Name of person making statement
Personally Known _ ,AOR Produced Identification
Type of Identification
Produced
(Signatu4cf NNbtary Public- Stktt?'fl�FI r1 a i tary Public -State o
JOYCE MICHi
mmission Noy r `'' JOYCEMlCHl1UD MYCOMMISSION#r�182383
Co
. , MY COMMISSION # t3+~# `li" EXPIRES:Rpri{25.
EXPIRES: April 25, 2822 Bonded Thru Notary Public tlRderxniters
1 ` t
Bonded'fhm Notary Public Lim
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17