HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO 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
PERMIT APPLICATION FOR: To Select from drophox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �r "?`-�' _/�C irr C.,,�
Legal Description:� -( _ 5 L
Property Tax ID Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
c L C E0 /"
CONSTRUCTION INFORMATION:
itiona wor to e e arme under this perm it---c ec a app Y:
HVAC �Gas Tank E]Gas Piping shutters Q Windows/Doors
Electric Plumbing E]Sprinklers Generator ORoof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor.lo
Cost of Construction:$ -� c%C Utilities: 0 Sewer L�J Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name � ,.
•- S Name:
Address: ' ` _ S Company: L
City: S -- State: L Address: r �. i
Zip Code: ' �- S�'- "7 Fax. city:
L State:z.�_
Phone No. ,; - i Zip C de: �:( 5a7 Fax:
E-Mail:
Phone No. :)21 �3-
Fill in fee simple Title Holder on next page j If different E-Mail:G
from the Owner listed above) State or County License: G A
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required,
SUPPLEMENTAL CONSTRUCTION LIEN LAIN 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.Lucre 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
=Owner/
rdin our Notice of Commencement,
ontractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S C COUNTY OF ">= C_r.C_
The forgoing instrument was acknowledgeo before me The forgoing instrument was acknowledged before me
this 31.( day of C--r— 20 by this::�l day of � ,20 by
Name or perso making statement Name of perso making statement
Personally Known OR Produced Identification . Personally Known p OR Produced Identification
Type of identificatio FlOTAR Tio Type of Identification HO*w Tio
Produced NOTARY Pt161lC Produced Y PUBLIC
Ccrtin�#FF192528
FLORIDAS and STATE OF FLORIDA
`ls
roe 1/26/2019 C%J FF192sn
(Signature of Notary Public-State of Florida} (Signature of Notary Public- tate of Florida)
Commission No. EE (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