HomeMy WebLinkAboutBuilding PermitALL 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'
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
�
Property Tax ID �bl " 0_1' 0 -':SS -6
Lot No.
Block No.
Site Plan Name
Name: e C
Project
Setbacks Front Back: Right Side: _ Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional worK to 0C out lormed1.11 11C el ti Iis permit - cec a app y:
F]Gas Shutters
Q Windows/Doors
❑HVAC Gas Tank Piping _
1-1 Electric Plumbing Sprinklers Generator
® Roof Roof pitch
Total Sq. Ft of Construction: (.ion a Sq- Ft. of First Floor:
E]
Cost of Construction: $ `7 goo ' U U _ Utilities:E Sewer Septic
Building Height:
OWNER/LESSEE: 1 W1y 1 rcHk— 1 Vrt:
Name \
Address: --
City: Stater
Zip Code Fax:
Phone No
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Company-
':` •. . t. �.
Address. • �f�► �i •
—0
•
Phone No.,. V •
»•• •i��• • �._ •�.
State
or • - - —
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Ci_._ Not Applicable
Name:
Address:
City:
Zip: Phone
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone:_
State:
A_ Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY-
Name:—
Address:
OMPANY:
Name:_Address:
City:T
Zip:
Phone:
_)L Not Applicable
State:
Not Applicable
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..
w Lucie County makes no representationapplicable Home Assoclationl ru esaby bylaws or and covenants that maydrestrictbor prct ohibit such
which is in conflict with any app
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may appy.
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
L, f the first inspection. If you intend to obtain financing, consult with lender or an attorney before
C: ore
commencing work or recording our Notice of Commencement.
['Signoere�of Owner/ Lessee/Contractor as Agent for Owner
Signa re of Contractor/License Holder
STATE OF FLORIDA— /
STATE OF FLORIDA
CvG�,
COUNTY OF ,}J �R
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
A,-,- 20_/1 by
this J�_ day of fr-�- , 20/ IT by
this —� day ofy ,
Name of person making statement
Name of person making statement
X
Personally Known )(_ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Sig ture of Notary Public, of Flori KKENNY
�� ' ' °
(Sign re of Notary Public St�l��lorida KKENNY
' m ssion # GG 144499
com I ion # GG 144499
Commission No. September 19,2021
*08tv
Commission No. Expires ARber19,2021
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d� iiYMOM 1MI�Ml1lMAM�
oQ� WNW ThiuBudget Notary services
REVIEWS ZONING SUPERVISOR
PLANS
REVIEW VEGETATION SE REVIEW LE MANGROVE
REVIEW
CFRONT
OUNTER REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17