HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUSTBECOMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1
�- - RECEIVED
Building Permit Application DEC 13 2018
Planning and Development Services
Building and Code Regulation Division Permitting Department
2300 Virginia Avenue,Fort Pierce FL 34982
cie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
"PROPOSED]MPROVEMENT LOCATION:
Address:_1-/$ lI Tce c Toe Tra;l �; Fer:F er't rcf- FL 3y 9S/
Legal Description: 1 Ag 3 y y 0 S %z o N E %y o f Sw I�2 c'
liy -LESS E 30 AC-)
Property Tax ID#: 19! 19 - a H 3 - d o 1 D - 000 - 10 Lot No.
Site Plan Name: Fc..cc. 00 4 h Block No.
Project Name: C ./[•W Fc KC--
Setbacks Front Back: 'J 6 Right Side: D Left Side: S
DETAILED DESCRIPTION OF WORK:
70 7 8
CONSTRUCTION INFORMATION: _
Acid itiona I work to be performed under this permit-check k a appy:'
HVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
Electric 0 Plumbing ❑Sprinklers []Generator or g Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ?,000 Utilities:[]Sewer Septic Building Height:
OU1/N ERA8SEE: CONTRACTOR:
Name Fr%'c. C4-.m./ Name:
Address: 49 if T,(ee. Toe Trc,;l Company:
City: R . pi corc-t-- State: FL Address:
Zip Code: 3 y p / Fax: City: State:
Phone No. 702- ('o (0 - D y 8 Zip Code: Fax:
E-Mail: e i (—v c) C o 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.
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.
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 encement.
Wti� v
Sign re of Owner/Lessee/Contractor s Agent f 9 Signature of Contractor/License Holder
=0
STATE OF FLORIDA rsW z STATE OF FLORIDA
COUNTY OF COUNTY OF
>W
The folgoing instr ent was acknowledge before e m The forgoing instrument was acknowledged before me
this day of e 20la'by �°b;,, this day of 20_ by
_ l yYa'
Name of person making statement Name of person making statement
Personal) wn OR Produced Identification Personally Known OR Produced Identification
Type of I ntifi tion / Type of Identification
Produced - kXC_ • Produced
(Signature of Not Public-State of Florida (Signature of Notary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17