HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED pp
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 dropbox, click arrow at the end of line
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Address: 3 �B e:01- ! R, I ql n
Legal Description: 9r1U1�1�C eA� Coy,01�'' C ( � �u ` Kf�U all. 'D
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Property Tax ID#: 3 a 7 -7.01` 00 TV a�� Lot No.
Site Plan Name: Block No.
Project Name: .
Setbacks Front Back: Right Side: Left Side:
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Additional work toe Dertormed under this permit-check a appy:
HVAC0 Gas Tank Gas Piping _Shutters [2/Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator F1 Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ �� q0+ eq Utilities:n Sewer Septic Building Height:
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Name n0_<> 4 V Name: PO/6-
Address: 310y �i Abe
be Company: b9ie!!.S A-VA� /l102L-Ir
City: PfC C State: Address: Y3 7 /mil YU
Zip Code: 3 Q Fax: City: rfiAreState:,taL
Phone No. -7,1 Zip Code: �_qf� Fax:
E-Mail: Phone No. I?)-- Y09� 9S0
Fill in fee simple Title Holder on next page(if different E-Mail: kgn/i V dool--sand ty re " , 491Y)
from the Owner listed above) State or County License: C12C �3 I5-yo
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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OR
DESIGNER/ENGINEER: _Not Applicable MORTGAGECOMPANY: _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 of Commencement.
P/1 A/1e- �t,
Signatur6 of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OFrFLORIDA
COUNTY OFCOUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this -1'6-day of c 20-M by this�day of 20-A by
Name of person making 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 o Notary Pu (Signature of otary
", BETTY PRIDE :'' e'Comm n 8G198661
Commission No.
44%1' COMMPW�GG198661 Commission No. P�' Expires 44.2022
:•�. ,k` Expires July 2,2022 Ttwu T800,�5�T019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17