HomeMy WebLinkAbout0819_001ALL APPLICAB E INF9 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED lrqRqvEm ENT LOCATION:
Address:
q
Legal Description( 1 -Y-
Property Tax ID #: �?)b
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
`Artion or to e e Orme under tis perms -checka appy: ` - `—
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator g Roof
Roof pitch
Total Sq. Ft of Construction:_ S Ft. of FirstFloor: _
Cost of Construction: $ (Ao Utilities:11 Sewer F1 Septic Building Height:
OWNER/LESSEE:
I CONTRACTOR:
Name Name:
, ./`
Address:C '�x'C.�- Company: `
l `•'�
City: A State: a,_— A dress:
Zip Code: � Fax: City:
Stag
,r�
Phone No� ("�[: c Zip Code; O Fax:
--c he'�Z_
E -Mail: Phone N
Fill in fee simple Title Holder on next page ( if different E -Mail- ('
from the Owner listed above) State or County License:
I
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: _ ,_ Phone
Not Applicable
State
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: ___ Phone:
Not Applicable
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: R Address:
City:_ City: 4
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
commencin work or recording your Notice of Commencement.
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Signature of wner/ Lessee/Co r for as A en or Owner Signature ofntractor/Licens H Ider
STATE OF FLORIDA STATE OF FLORI
COUNTY OF �P+V\ ivy l COUNTY OF ,�'% P^ �QrL
The fgr}tging inst� nt was actin ledge etre me
this F/' .ling
of ;, ►'iQ_ Oby
Name of person making statement
Personally Known %,-'- OR Produced Identification
Type of Identification
Produced
(Signaturl�of Notary Public- State
Commission t
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17
The f9aq,ing insti;u ent was acknciWedgelVkre me
this day of{7 tby
Name of person making statement
Personally Known _ OR Produced Identification
Type of Identification
Produced
ry Public- Stag of Florida )
JOYCEMICHAUD
MY COMMISSION # GG X19°
EXPIRES: April 25, 2022
Bonded Thru Nolary Public UrftwiNer1
SUPERVISOR j PLANS VEGETATION
REVIEW I REVIEW REVIEW
JOYCE MICHAUD
MY COMMISSION # GG'