HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (� I
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia A',venue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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PERMIT APPLICATION FOR:
PRaPOSE01 PROVEMEN LOCATION:
Address: 2 ,)e-\L,,, 04 . fa
Legal Description: 0,1._/2 ,-z- Z
Property Tax ID#: 39a L95a �(�(lu rQ(�(�' Lot No.
Site Plan.Name: Block No.
Project Name:! min�-�� �ejc)C e
Setbacks Front Back: Right Side: �./� Left Side:
DET FLED D -SCRK.
O
CO1��TR CTIE•' I FQR' ,AT(ON:
Additional work to be performed under tis permit-check all that appy:
_Mechanical _Gas Tank Gas Piping _Shutters —.Windows/Doors
Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �(?(7 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE. CONTRACTOR;
Name - Name:
Address: C4 Company:
city!? State: PL Address:
Zip Code: Fax: City: State:
Phone No.1%-' - zf0q Zip Code: Fax:
E-Mail: i.e�onCouzcecQoa n� Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
J
S • P EMEN1'A>_GQNST�{ CTI�N LIEN LAW IN�FQRMATION:.
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.
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 ali'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.
Signat wrier/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing insplent was acknowledged before me The forgoing instrument was acknowledged before me
this]r— Y of 201 by this day of 20_ by
Name of person4naking statement. Name of person making statement.
Personally Known OR Produced Identification �� Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-Stat of Florida) (Signature of Notary Public-State of Florida)
Commission No. is l) A►NGRAM (Seal)
%�QY PVB,' Notary Public-Stale of FIo20d18; Commission No.
Expires Dee 20'd i
}} s n •oeF commit ion r %
t�=,,. Notary Assn
REVIEWS FRONT'�Z; pF�� �N1611Gsdthro :ViSOR PLANS VEGETATION SEA TURTLE MANGROVE
COUN ;E - EV REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17