HomeMy WebLinkAboutScanALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�COUNTY
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:
Address: &%%-7 �Vv,-,�_ v
Legal Description: WOXI IDcttL -Lt'4it i
Property Tax ID#: 7"035,2--o_4v2
Lot No.
Site Plan Name: Block No. S?�
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be nerformed under this permit — c ec allappy:
L�JHVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
11Electric ❑Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ '3 �_ JJ
Sq. Ft. of First Floor: _
Utilities:Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
NameT � lU:`i r) 5nn
Name:
Address: i a,� C "q L"�z,
Company.
06A1;4 zy , �' <L�r
Address: ,
City: VC �o { �'1 C 6, '
Zip Code: Fax:
State: f- I—
City: Vef b ` eo_c �i State:
Zi Code3),
Zip Fax:
P h o n e
Phone No. 772 -Lf 73 C)
E -Mail:
Phone No. 772 -:` 3"r _G,20g2
Fill in fee simple Title Holder on next page ( if different
E -Mail:
from the Owner listed above)
----
State or County License: •S n a t:� ,
4� CSC/ 1V 374?
-o.— .TL..rvu V1 1111ire, a n-wnvry wotice OT lAmmencement is required.
Ilc.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: a! Not Applicable MORTGAGE COMPANY: Z 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 thepermit 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 of Commencement.
Signature of OWner/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF =jr j 1 ; (' ,�;.� ,� y
COUNTY OF 54
The fir oing instrument was acknowledged before me
this d ay of LO C V M L-je�' 20� by
The fq�oipg instr ment was acknowledged efore me
this' ay V�
of 20�by
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known _ i/ OR Produced Identification
Type of Identification
Type of Identification
Produced
C,�AJ��V
Produced
-
(Signature of Notary
deo- State of lorida)
(Signature of Notary Public- State of e`Otf�'aSA.
oP IAZ
Commission No, i • .� *MY COMMISStOJg977356
^� EXPIRES: March
INESA. DIAZ
Commission N6> MYCOMMISSIONNGG077
"' a al 6pIRES:
o�Ll
18, 2021
lFOF F' Bor4W Ttru Budget Notary SwAc"
c March 18, 202
�FOF F�°�\ Baidrd Thru Budget Notary
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
tev. 8/2/17